COX-2抑制剂在腹腔镜胆囊切除术患者围术期疼痛管理中的应用效果研究
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摘要
目的探讨加速康复外科理念下选择性环氧化酶-2(COX-2)在腹腔镜胆囊切除术患者围术期超前镇痛中的应用效果。方法回顾性分析2016年6-12月该院胆道外科收治的应用选择性COX-2抑制剂超前镇痛的206例胆囊结石患者(新型镇痛组)和2015年6-12月收治的198例应用曲马多进行术后镇痛的胆囊结石患者(传统镇痛组)的临床资料。两组患者术中麻醉方案一致,术后采用相同的疼痛解救方案;对比分析两组患者围术期视觉模拟评分法(VAS)评分、疼痛解救药物使用率、不良反应、满意度及住院时间。结果新型镇痛组患者术后2、6、12、24hVAS评分均低于传统镇痛组,差异有统计学意义(P<0.05);新型镇痛组患者的解救镇痛药物使用率低于传统镇痛组(14.56%vs.44.95,P<0.05),盐酸曲马多及盐酸哌替啶的使用率均低于传统镇痛组(P<0.05)。新型镇痛组患者不良反应总发生率更少(2.43%vs.36.36%,P<0.05),新型镇痛组患者恶心、呕吐发生率低于传统镇痛组(P<0.05),其余各项并发症发生率差异无统计学意义(P>0.05)。新型镇痛组患者围术期的镇痛满意度高于传统镇痛组(P<0.05),平均住院时间和术后住院时间差异无统计学意义(P>0.05)。结论 COX-2抑制剂能有效降低腹腔镜胆囊切除术患者围术期的疼痛程度,减少解救镇痛药物的使用频率,降低不良反应发生率,缩短住院时间,提升患者满意度。
Objective To investigate the application effect of selective cyclooxygenase-2(COX-2)inhibitor in perioperative preemptive on-demand analgesia of the patients with laparoscopic cholecystectomy under enhanced recovery after surgery(ERAS).Methods The clinical data in 206 cases of gallstones undergoing selective COX-2 inhibitor for preemptive analgesia(new type analgesic group)from June to December 2015 and198 cases of gallstones undergoing tramadol postoperative analgesia(traditional analgesia group)in the biliary surgery department of West China Hospital of Sichuan University were retrospectively analyzed.The intraoperative anesthesia schemes in the two groups were consistent.The same pain resolution scheme was adopted after operation.Then the VAS pain score,pain relief drug use rate,adverse reactions,analgesic satisfaction and hospitalization time were compared between the two groups.Results The VAS scores at postoperative 2,6,12,24 hin the new type analgesia group were lower than those in the traditional analgesia group,the difference was statistically significant(P<0.05);the analgesic drug use rate in the new type analgesia group was lower than that in the traditional analgesia group(14.56% vs.44.95%,P<0.05),and the use rate of tramadol hydrochloride and pethidine hydrochloride was lower than that in the traditional analgesia group(P<0.05).The incidence rate of adverse reactions in the new type analgesia group was lower(2.43% vs.36.36%,P<0.05).The incidence rate of nausea and vomiting in the new type analgesia group was lower than that in the traditional analgesia group(P<0.05),and the incidence rate of other complications had no statistically significant difference(P>0.05).The perioperative patient analgesia satisfaction the in the new type analgesia group was higher than that in the traditional analgesia group(P<0.05);the average hospital stay and postoperative hospital stay had no statistical difference between the two groups(P>0.05).Conclusion COX-2 inhibitors can effectively reduce perioperative pain degree in the patients with laparoscopic cholecystectomy,reduces the use frequency of analgesic drugs,shortens the hospital stay time and increases the patient satisfaction.
Objective To investigate the application effect of selective cyclooxygenase-2(COX-2)inhibitor in perioperative preemptive on-demand analgesia of the patients with laparoscopic cholecystectomy under enhanced recovery after surgery(ERAS).Methods The clinical data in 206 cases of gallstones undergoing selective COX-2 inhibitor for preemptive analgesia(new type analgesic group)from June to December 2015 and198 cases of gallstones undergoing tramadol postoperative analgesia(traditional analgesia group)in the biliary surgery department of West China Hospital of Sichuan University were retrospectively analyzed.The intraoperative anesthesia schemes in the two groups were consistent.The same pain resolution scheme was adopted after operation.Then the VAS pain score,pain relief drug use rate,adverse reactions,analgesic satisfaction and hospitalization time were compared between the two groups.Results The VAS scores at postoperative 2,6,12,24 hin the new type analgesia group were lower than those in the traditional analgesia group,the difference was statistically significant(P<0.05);the analgesic drug use rate in the new type analgesia group was lower than that in the traditional analgesia group(14.56% vs.44.95%,P<0.05),and the use rate of tramadol hydrochloride and pethidine hydrochloride was lower than that in the traditional analgesia group(P<0.05).The incidence rate of adverse reactions in the new type analgesia group was lower(2.43% vs.36.36%,P<0.05).The incidence rate of nausea and vomiting in the new type analgesia group was lower than that in the traditional analgesia group(P<0.05),and the incidence rate of other complications had no statistically significant difference(P>0.05).The perioperative patient analgesia satisfaction the in the new type analgesia group was higher than that in the traditional analgesia group(P<0.05);the average hospital stay and postoperative hospital stay had no statistical difference between the two groups(P>0.05).Conclusion COX-2 inhibitors can effectively reduce perioperative pain degree in the patients with laparoscopic cholecystectomy,reduces the use frequency of analgesic drugs,shortens the hospital stay time and increases the patient satisfaction.
引文
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[9]KAYE A D,BALUCH A,KAYE A J,et al.Pharmacology of cyclooxygenase-2inhibitors and preemptive analgesia in acute pain management[J].Curr Opin Anaesthesiol,2008,21(4):439-445.
[10]梁树军.帕瑞昔布钠序贯塞来昔布对全髋关节置换围术期镇痛及关节功能恢复的效果观察[J].河北医学,2015,21(11):1869-1872.
[11]HUBBARD R C,NAUMANN T M,TRAYLOR L,et al.Parecoxib Sodium has opioid-sparing effects in patients undergoing total knee arthroplasty under spinal anaesthesia[J].Br J Anaesth,2003,90(2):166-172.
[12]MALAN T P,MARSH G,Hakki S,et al.Paracoxib Sodium,aparenteral cyclooxygenase 2selective inhibitors,improves morphine analgesia and is opioid-sparing following total hip arthroplasty[J].Anesthesiology,2003,98(4):950-956.
[13]KYRIAKIDIS A V,PERYSINAKIS I,ALEXANDRIS I,et al.Parecoxib Sodium in the treatment of postoperative pain after Lichtenstein tension-free mesh inguinal hernia repair[J].Hernia,2011,15(1):59-64.
[14]AKARAVIPUTH T,LEELOUHAPONG C,LOHSIRIWAT V,et al.Efficacy of perioperative parecoxib injection on postoperative pain relief after laparoscopic cholecystectomy:aprospective,randomized study[J].World J Gastroenterol,2009,15(16):2005-2008.
[15]WU X M,YUE Y,ZHANG L P,et al.Morphine-sparing effect and safety of parecoxib for postoperative analgesia[J].Chin J Anesthesiol,2007,27(1):7-10.
[16]卢玉蓉,韩冲芳,高俊伟,等.帕瑞昔布钠术前用于腹腔镜胆囊切除术的镇痛效果评价[J].当代医学,2012,18(18):40-41.
[2]DI MASSA A,AVELLA R,GENTILI C.Respiratory dysfunction related to diaphragmatic shoulder pain after abdominal and pelvic laparoscopy[J].Minerva Anestesiol,1996,62(5):171-176.
[3]RATCHANON S,PHALOPRAKARN C,TRAIPAK K.Pain control in laparoscopic gynecologic surgery with/without preoperative(preemptive)parecoxib Sodium injection:a randomized study[J].J Med Assoc Thai,2011,94(10):1164-1168.
[4]于浩淼,白晓东,马立峰,等.环氧化酶2抑制剂帕瑞昔布塞来昔布在TKA围手术期多模式镇痛中的效果研究[J/CD].中华损伤与修复杂志(电子版),2014,9(6):634-639.
[5]黄宇,尹东,莫冰峰.帕瑞昔布钠联合塞来昔布在全髋关节置换围术期的应用[J].重庆医学,2014,43(3):335-337.
[6]张波,金岩,巩红,等.3 542例患者使用帕瑞昔布术后镇痛情况的多中心回顾性分析[J].中国药学杂志,2013,48(12):1005-1009.
[7]郭立志,任进民.常用选择性环氧合酶-2抑制剂的临床研究进展[J].实用疼痛学杂志,2008,4(6):445-450.
[8]刘海,陈刚,王志红,等.帕瑞昔布钠超前镇痛对老年患者应激、炎性反应及术后认知功能的影响[J/CD].中华临床医师杂志(电子版),2014(12):2238-2241.
[9]KAYE A D,BALUCH A,KAYE A J,et al.Pharmacology of cyclooxygenase-2inhibitors and preemptive analgesia in acute pain management[J].Curr Opin Anaesthesiol,2008,21(4):439-445.
[10]梁树军.帕瑞昔布钠序贯塞来昔布对全髋关节置换围术期镇痛及关节功能恢复的效果观察[J].河北医学,2015,21(11):1869-1872.
[11]HUBBARD R C,NAUMANN T M,TRAYLOR L,et al.Parecoxib Sodium has opioid-sparing effects in patients undergoing total knee arthroplasty under spinal anaesthesia[J].Br J Anaesth,2003,90(2):166-172.
[12]MALAN T P,MARSH G,Hakki S,et al.Paracoxib Sodium,aparenteral cyclooxygenase 2selective inhibitors,improves morphine analgesia and is opioid-sparing following total hip arthroplasty[J].Anesthesiology,2003,98(4):950-956.
[13]KYRIAKIDIS A V,PERYSINAKIS I,ALEXANDRIS I,et al.Parecoxib Sodium in the treatment of postoperative pain after Lichtenstein tension-free mesh inguinal hernia repair[J].Hernia,2011,15(1):59-64.
[14]AKARAVIPUTH T,LEELOUHAPONG C,LOHSIRIWAT V,et al.Efficacy of perioperative parecoxib injection on postoperative pain relief after laparoscopic cholecystectomy:aprospective,randomized study[J].World J Gastroenterol,2009,15(16):2005-2008.
[15]WU X M,YUE Y,ZHANG L P,et al.Morphine-sparing effect and safety of parecoxib for postoperative analgesia[J].Chin J Anesthesiol,2007,27(1):7-10.
[16]卢玉蓉,韩冲芳,高俊伟,等.帕瑞昔布钠术前用于腹腔镜胆囊切除术的镇痛效果评价[J].当代医学,2012,18(18):40-41.