帕瑞昔布联合胸段硬膜外镇痛对胸外科手术的影响
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摘要
目的:探讨帕瑞昔布联合胸段硬膜外镇痛对胸外科手术的影响。方法:按照随机数字表法将2017年5月—2018年5月我院收治的80例胸外科手术患者分为观察组和对照组,各40例,两组均给予胸段硬膜外镇痛,观察组在此基础上加用帕瑞昔布(术前30 min将40 mg帕瑞昔布加入至4 mL0.9%氯化钠注射液中静脉注射,术后每隔12 h给予同等剂量帕瑞昔布静脉注射1次,连续注射至术后72 h)镇痛,比较两组手术情况、麻醉情况、麻醉不良反应、术后疼痛程度变化情况以及手术前后血清白细胞介素(IL)-6、IL-8水平。结果:两组麻醉时间、手术时间、术中出血量、苏醒时间比较,差异无统计学意义(P> 0.05);观察组Ramsay镇静评分高于对照组,差异有统计学意义(P <0.05);观察组术后15 min、12 h、24 h、72 h视觉模拟评分法(VAS)评分均低于对照组,差异有统计学意义(P <0.05);观察组术后24 h IL-6、IL-8水平均低于对照组,差异有统计学意义(P <0.05);观察组苏醒期躁动发生率低于对照组,差异有统计学意义(P <0.05)。结论:帕瑞昔布联合胸段硬膜外镇痛能够提高胸外科手术镇静效果,减轻患者术后疼痛程度和手术应激,值得临床推荐。
Objective:To investigate the effect of parecoxib combined with thoracic epidural analgesia on thoracic surgery. Methods:According to the random number table method, 80 patients undergoing thoracic surgery admitted to our hospital from May 2017 to May 2018 were divided into an observation group and a control group,40 cases each. The patients in the two groups were given thoracic epidural analgesia. On this basis, the patients in the observation group were treated with parecoxib(40 mg parecoxib was added to 4 mL 0.9% sodium chloride injection at 30 min before surgery for intravenous injection, and the same dose of parecoxib was given once every 12 hours after surgery, continuous injection to 72 hours after surgery) for analgesia. The surgery condition, anesthesia condition, adverse reactions caused by anesthesia, postoperative pain degree changes and serum interleukin(IL)-6 and IL-8 levels before and after surgery were compared between the two groups. Results:There were no statistically signi?cant differences in anesthesia time, surgery time, intraoperative blood loss and awakening time between the two groups(P>0.05). The Ramsay sedation scores in the observation group were higher than those in the control group,and the difference was statistically signi?cant(P<0.05). The visual analogue scale(VAS) scores at 15 min, 12 h, 24 h and 72 h after surgery in the observation group were lower than those in the control group, and the differences were statistically signi?cant(P<0.05). The levels of IL-6 and IL-8 at 24 h after surgery in the observation group were lower than those in the control group, and the differences were statistically signi?cant(P<0.05). The incidence of agitation during awakening in the observation group was lower than that in the control group, and the difference was statistically signi?cant(P<0.05). Conclusion:Parecoxib combined with thoracic epidural analgesia can improve the sedative effect in thoracic surgery and reduce the degree of postoperative pain and surgical stress, which is worthy of clinical recommendation.
Objective:To investigate the effect of parecoxib combined with thoracic epidural analgesia on thoracic surgery. Methods:According to the random number table method, 80 patients undergoing thoracic surgery admitted to our hospital from May 2017 to May 2018 were divided into an observation group and a control group,40 cases each. The patients in the two groups were given thoracic epidural analgesia. On this basis, the patients in the observation group were treated with parecoxib(40 mg parecoxib was added to 4 mL 0.9% sodium chloride injection at 30 min before surgery for intravenous injection, and the same dose of parecoxib was given once every 12 hours after surgery, continuous injection to 72 hours after surgery) for analgesia. The surgery condition, anesthesia condition, adverse reactions caused by anesthesia, postoperative pain degree changes and serum interleukin(IL)-6 and IL-8 levels before and after surgery were compared between the two groups. Results:There were no statistically signi?cant differences in anesthesia time, surgery time, intraoperative blood loss and awakening time between the two groups(P>0.05). The Ramsay sedation scores in the observation group were higher than those in the control group,and the difference was statistically signi?cant(P<0.05). The visual analogue scale(VAS) scores at 15 min, 12 h, 24 h and 72 h after surgery in the observation group were lower than those in the control group, and the differences were statistically signi?cant(P<0.05). The levels of IL-6 and IL-8 at 24 h after surgery in the observation group were lower than those in the control group, and the differences were statistically signi?cant(P<0.05). The incidence of agitation during awakening in the observation group was lower than that in the control group, and the difference was statistically signi?cant(P<0.05). Conclusion:Parecoxib combined with thoracic epidural analgesia can improve the sedative effect in thoracic surgery and reduce the degree of postoperative pain and surgical stress, which is worthy of clinical recommendation.
引文
[1]廖小勇,葛明建.胸外科术后镇痛研究进展[J].医学综述2018,24(3):581-585.
[2]李迅驰,胡瑞兰,王振华.帕瑞昔布钠对单孔胸腔镜肺叶切除术患者超前镇痛效果及应激反应的观察[J].中华肺部疾病杂志(电子版),2016,9(6):647-649.
[3]Nair AV,Shamsuddin K,John PS,et al.Correlation of visual analogue scale foot and ankle(VAS-FA)to AOFAS score in malleolar fractures using Indian langu age q ues tio nnar e[J].F oo t A nk le S urg,201 5,21(2):125-131.
[4]杨杰,雷跃昌,金健,等.胸外科开胸手术后镇痛的研究进展[J].四川解剖学杂志,2015,23(3):24-27,44.
[5]王伟霞.胸外科病人术后疼痛的相关因素、镇痛及护理[J].中国地方病防治杂志,2014,29(S2):298-299.
[6]张毅,张琴,Nguz A.Kutshid,等.帕瑞昔布钠联合阿片类镇痛药和B超引导椎旁神经阻滞对于非心脏手术开胸术后镇痛效果评价[J].华中科技大学学报(医学版),2013,42(4):419-423.
[7]史晓燕.帕瑞昔布钠联合地佐辛超前镇痛对开胸手术患者术后舒芬太尼静脉自控镇痛效果的观察[J].中国药物与临床,2013,13(1):95-97.
[8]Ling XM,Fang F,Zhang XG,et al.Effect of parecoxib combined with thoracic epidural analgesia on pain after thoracotomy[J].J Thorac Dis,2016,8(5):880-887.
[9]李小刚,童华,周荣胜,等.帕瑞昔布对胸腔镜肺叶切除术围术期疼痛和炎性细胞因子的影响[J].西安交通大学学报(医学版),2013,34(5):659-663.
[10]Yang W,Ming YC,Kau YC,et al.A comparison of parecoxib and thoracic epidural analgesia for postoperative analgesia following Nuss procedure[J].J Pediatr Surg,2015,50(12):2032-2034.
[11]荆丽君,王永明.帕瑞昔布钠和胸腔镜手术对胸科术后炎症因子的影响[J].现代预防医学,2014,41(19):3638-3639,3648.
[12]贺克强,柴小青,陈昆洲,等.地佐辛联合帕瑞昔布钠对开胸手术患者全麻苏醒期躁动的影响[J].临床麻醉学杂志2012,28(2):149-151.
[2]李迅驰,胡瑞兰,王振华.帕瑞昔布钠对单孔胸腔镜肺叶切除术患者超前镇痛效果及应激反应的观察[J].中华肺部疾病杂志(电子版),2016,9(6):647-649.
[3]Nair AV,Shamsuddin K,John PS,et al.Correlation of visual analogue scale foot and ankle(VAS-FA)to AOFAS score in malleolar fractures using Indian langu age q ues tio nnar e[J].F oo t A nk le S urg,201 5,21(2):125-131.
[4]杨杰,雷跃昌,金健,等.胸外科开胸手术后镇痛的研究进展[J].四川解剖学杂志,2015,23(3):24-27,44.
[5]王伟霞.胸外科病人术后疼痛的相关因素、镇痛及护理[J].中国地方病防治杂志,2014,29(S2):298-299.
[6]张毅,张琴,Nguz A.Kutshid,等.帕瑞昔布钠联合阿片类镇痛药和B超引导椎旁神经阻滞对于非心脏手术开胸术后镇痛效果评价[J].华中科技大学学报(医学版),2013,42(4):419-423.
[7]史晓燕.帕瑞昔布钠联合地佐辛超前镇痛对开胸手术患者术后舒芬太尼静脉自控镇痛效果的观察[J].中国药物与临床,2013,13(1):95-97.
[8]Ling XM,Fang F,Zhang XG,et al.Effect of parecoxib combined with thoracic epidural analgesia on pain after thoracotomy[J].J Thorac Dis,2016,8(5):880-887.
[9]李小刚,童华,周荣胜,等.帕瑞昔布对胸腔镜肺叶切除术围术期疼痛和炎性细胞因子的影响[J].西安交通大学学报(医学版),2013,34(5):659-663.
[10]Yang W,Ming YC,Kau YC,et al.A comparison of parecoxib and thoracic epidural analgesia for postoperative analgesia following Nuss procedure[J].J Pediatr Surg,2015,50(12):2032-2034.
[11]荆丽君,王永明.帕瑞昔布钠和胸腔镜手术对胸科术后炎症因子的影响[J].现代预防医学,2014,41(19):3638-3639,3648.
[12]贺克强,柴小青,陈昆洲,等.地佐辛联合帕瑞昔布钠对开胸手术患者全麻苏醒期躁动的影响[J].临床麻醉学杂志2012,28(2):149-151.