帕瑞昔布钠超前镇痛对垂体后叶素致腹腔镜子宫肌瘤剔除术后宫缩痛的影响
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摘要
目的探讨帕瑞昔布钠超前镇痛对垂体后叶素致腹腔镜子宫肌瘤剔除术后宫缩痛的影响。方法选择2017年11月至2018年3月首都医科大学宣武医院行腹腔镜子宫肌瘤剔除术患者纳入研究,随机分为生理盐水组(N组)和帕瑞昔布钠组(P组)。麻醉诱导前10 min,N组静脉注射生理盐水4 ml,P组静脉注射帕瑞昔布钠40 mg(生理盐水稀释至4 ml)。所有患者术中均采用持续输注丙泊酚、瑞芬太尼及右美托咪定全凭静脉麻醉。子宫肌瘤剔除前子宫壁肌瘤周围注射垂体后叶素12 U。术后行患者自控静脉镇痛,两组镇痛泵配置方案均为:羟考酮1 mg/kg+托烷司琼10 mg,加生理盐水配制成100 ml。分别于术后2 h(T_1)、4 h(T_2)、6 h(T_3)、24 h(T_4)、48 h(T_5)评估宫缩痛[视觉模拟评分(visual analogue score, VAS)]评分及Ramsay评分。记录术后镇痛期间羟考酮用量、患者睡眠情况、患者镇痛满意度评分。记录术后恶心、呕吐、过度镇静、呼吸抑制、尿潴留等不良反应发生情况。结果本研究共纳入60例患者,每组30例。与N组比较,P组T1~T4时点宫缩痛VAS评分降低(P <0.05),48 h羟考酮使用量降低(P <0.05),镇痛满意度评分升高(P <0.05),睡眠质量较好(P <0.05)。两组患者不同时点Ramsay评分差异无统计学意义(P>0.05);术后恶心、呕吐、尿潴留等不良反应发生率差异无统计学意义(P> 0.05)。结论帕瑞昔布钠40 mg超前镇痛可减轻垂体后叶素致腹腔镜子宫肌瘤剔除术后宫缩痛,减少羟考酮用量,提高患者满意度,改善睡眠质量。
Objective To investigate the effect of parecoxib sodium preemptive analgesia in postoperative uterine contraction pain caused by pituitrin in laparoscopic hysteromyomectomy patients. Methods The patients underwent laparoscopic hysteromyomectomy(Nov 2017 to Mar 2018)were randomly divided into 2 groups:normal saline group(group N), parecoxib sodium group(group P). Group P received intravenous parecoxib 40 mg/4 ml at 10 min before anesthesia induction and group N received normal saline 4 ml instead of parecoxib sodium. All patients received total intravenous anesthesia with infusion of propofol, remifentanil and dexmedetomidin for intravenous anesthesia. 12 units of pituitrin were injected into the uterine wall before myomectomy. Patient-controlled intravenous analgesia(PCIA) pump was connected at the end of surgery. PCIA solution contained oxycodone 1 mg/kg and tropisetron 10 mg diluted to 100 ml in both groups.Visual analog scales(VAS) for uterine contraction pain were assessed at 2(T1), 4(T2), 6(T3), 24(T4) and 48 h(T5), postoperatively. Ramsay sedation scores were also assessed at the same time points. The amounts of oxycodone,sleep quality, the score of satisfaction with the analgesic regimen of postoperative analgesia were recorded. The occurrence of adverse events(nausea, vomiting, over sedation, respiratory depression, urinary retention) were also recorded.Results Compared with group N, VAS of uterine contraction pain at T1-4 and the dosage of oxycodone at T5 significantly decreased in group P(P < 0.05). The satisfaction score with the analgesic regimen was significantly higher in group P than that in group N(P < 0.05). The sleep quality of group P was also better than that of group N(P < 0.05). There were no differences in the score of Ramsay sedation scale and the incidence of adverse effects between two groups. Conclu?sions Preemptive analgesia with parecoxib sodium 40 mg can relieve the postoperative uterine contraction pain caused by pituitrin in laparoscopic hysteromyomectomy patients with less amount of oxycodone.
Objective To investigate the effect of parecoxib sodium preemptive analgesia in postoperative uterine contraction pain caused by pituitrin in laparoscopic hysteromyomectomy patients. Methods The patients underwent laparoscopic hysteromyomectomy(Nov 2017 to Mar 2018)were randomly divided into 2 groups:normal saline group(group N), parecoxib sodium group(group P). Group P received intravenous parecoxib 40 mg/4 ml at 10 min before anesthesia induction and group N received normal saline 4 ml instead of parecoxib sodium. All patients received total intravenous anesthesia with infusion of propofol, remifentanil and dexmedetomidin for intravenous anesthesia. 12 units of pituitrin were injected into the uterine wall before myomectomy. Patient-controlled intravenous analgesia(PCIA) pump was connected at the end of surgery. PCIA solution contained oxycodone 1 mg/kg and tropisetron 10 mg diluted to 100 ml in both groups.Visual analog scales(VAS) for uterine contraction pain were assessed at 2(T1), 4(T2), 6(T3), 24(T4) and 48 h(T5), postoperatively. Ramsay sedation scores were also assessed at the same time points. The amounts of oxycodone,sleep quality, the score of satisfaction with the analgesic regimen of postoperative analgesia were recorded. The occurrence of adverse events(nausea, vomiting, over sedation, respiratory depression, urinary retention) were also recorded.Results Compared with group N, VAS of uterine contraction pain at T1-4 and the dosage of oxycodone at T5 significantly decreased in group P(P < 0.05). The satisfaction score with the analgesic regimen was significantly higher in group P than that in group N(P < 0.05). The sleep quality of group P was also better than that of group N(P < 0.05). There were no differences in the score of Ramsay sedation scale and the incidence of adverse effects between two groups. Conclu?sions Preemptive analgesia with parecoxib sodium 40 mg can relieve the postoperative uterine contraction pain caused by pituitrin in laparoscopic hysteromyomectomy patients with less amount of oxycodone.
引文
[1]刘勇,盛洁,高鹏,等.小剂量垂体后叶素联合缩宫素在腹腔镜子宫肌壁间肌瘤剔除术中的止血效果观察[J].北京医学,2017,39:1129-1131.
[2]梅松原,刘艳庚,韩秋丽,等.垂体后叶素或缩宫素在腹腔镜肌壁间子宫肌瘤剔除术中应用的对比研究[J].中国微创外科杂志,2011,11:801-804.
[3]Deussen AR,Ashwood P,Martis R.Analgesia for relief of pain due to uterine cramping/involution after birth[J].Cochrane Database Syst Rev,2011,11:CD004908.
[4]康凯,王玥,李杉,等.两种非甾体类镇痛药对老年妇瘤腹腔镜手术术后疼痛及认知功能影响的临床研究[J].北京医学,2016,38:1160-1163.
[5]徐一刚,孙正英,孙杰,等.帕瑞昔布钠在经产妇剖宫产术后减轻子宫收缩痛的观察[J].临床麻醉学杂志,2015,31:885-887.
[6]Llord R,Derry S,Moore RA,et al.Intravenous or intramuscular parecoxib for acute postoperative pain in adults[J].Cochrane Database Syst Rev,2009,2:CD004771.
[7]陈明慧,章小龙,傅舒昆,等.帕瑞昔布钠超前镇痛的有效性评价:meta分析[J].中华麻醉学杂志,2013,33:279-281.
[8]屈江波,陈建平,郭张华,等.帕瑞昔布钠预注对妇科腹腔镜手术患者医疗舒适度的影响[J/CD].中华临床医师杂志(电子版),2013,7:3162-3163.
[9]徐世琴,夏凡,汪福洲,等.帕瑞昔布钠超前镇痛对全子宫切除术病人凝血功能的影响:随机、双盲、对照研究[J].中华麻醉学杂志,2010,30:549-551.
[2]梅松原,刘艳庚,韩秋丽,等.垂体后叶素或缩宫素在腹腔镜肌壁间子宫肌瘤剔除术中应用的对比研究[J].中国微创外科杂志,2011,11:801-804.
[3]Deussen AR,Ashwood P,Martis R.Analgesia for relief of pain due to uterine cramping/involution after birth[J].Cochrane Database Syst Rev,2011,11:CD004908.
[4]康凯,王玥,李杉,等.两种非甾体类镇痛药对老年妇瘤腹腔镜手术术后疼痛及认知功能影响的临床研究[J].北京医学,2016,38:1160-1163.
[5]徐一刚,孙正英,孙杰,等.帕瑞昔布钠在经产妇剖宫产术后减轻子宫收缩痛的观察[J].临床麻醉学杂志,2015,31:885-887.
[6]Llord R,Derry S,Moore RA,et al.Intravenous or intramuscular parecoxib for acute postoperative pain in adults[J].Cochrane Database Syst Rev,2009,2:CD004771.
[7]陈明慧,章小龙,傅舒昆,等.帕瑞昔布钠超前镇痛的有效性评价:meta分析[J].中华麻醉学杂志,2013,33:279-281.
[8]屈江波,陈建平,郭张华,等.帕瑞昔布钠预注对妇科腹腔镜手术患者医疗舒适度的影响[J/CD].中华临床医师杂志(电子版),2013,7:3162-3163.
[9]徐世琴,夏凡,汪福洲,等.帕瑞昔布钠超前镇痛对全子宫切除术病人凝血功能的影响:随机、双盲、对照研究[J].中华麻醉学杂志,2010,30:549-551.