【摘要】 目的:观察不同时间点应用帕瑞昔布钠对腭咽成形术(uvulopalatopharyngoplasty,UPPP)患者术后镇痛效果的影响。方法:66例美国麻醉师协会(ASA)Ⅰ~Ⅱ级阻塞性睡眠呼吸暂停综合征(obstructivesleep apnea syndrome,OSAS)患者,随机分为3组(n=22)。Ⅰ组在全麻诱导前给予帕瑞昔布钠40 mg,Ⅱ组在手术结束时给予帕瑞昔布钠40 mg,Ⅲ组为普通全麻组(对照组)。手术结束后3组开启同样配方的患者静脉自控镇痛(patient-controlled intravenous analgesia,PCIA)泵。PCIA设置:以芬太尼作为术后镇痛药,背景剂量0.3μg.kg-1.h-1,锁定时间15 min,单次剂量0.3μg.kg-1,负荷剂量0.6μg.kg-1。观察并记录48 h内的疼痛视觉模拟评分(visual analog scale,VAS)、PCIA泵首次按压时间、累计按压次数及不良反应发生情况。结果:Ⅰ组术后1,2,4,8,12 h VAS低于Ⅱ,Ⅲ组(P<0.05),Ⅱ组1,2,4,8 h VAS低于Ⅲ组(P<0.05)。首次按压PCIA泵时间Ⅰ组明显晚于Ⅱ,Ⅲ组(P<0.01),Ⅰ组术后48 h内各时点累计按压次数明显低于Ⅱ,Ⅲ组(P<0.05)。Ⅰ组术后无恶心呕吐发生,Ⅱ组有1例术后出现恶心呕吐,Ⅲ组有4例(P<0.05)。其他如头痛头晕、畏寒发热、心悸、嗜睡、皮肤瘙痒等不良反应的发生率无统计学显著差异。结论:帕瑞昔布钠有较强的镇痛作用,麻醉诱导前静脉注射及术后静脉维持联合使用能发挥最佳的镇痛效果。更多还原

【Abstract】 Objective: To observe the analgesic effect of parecoxib sodium used at different time points in patients undergoing uvulopalatopharyngoplasty(UPPP).Methods: Sixty-six ASA I~II obstructive sleep apnea syndrome(OSAS) patients undergoing UPPP were randomly allocated into three groups(n=22 for each group).Parecoxib sodium 40 mg was given before the induction of general anesthesia(group I) or at the end of surgery(group II).Controls were anesthetized without parecoxib sodium(group III).All the patients received the same patient-controlled intravenous analgesia(PCIA,containing fentanyl as the analgesic drugs,background dose 0.3 μg·kg-1·h-1,lockout time 15 min,single dose 0.3 μg·kg-1,loading dose 0.6 μg·kg-1) at the end of surgery.The visual analog scale(VAS),the first and the total times of PCIA button press and side effects were recorded during 48 h after operation.Results: VAS score of group I was significantly lower than those of group II and III at 1,2,4,8,and 12 h(P<0.05),and that of group II was lower than that of group III at 1,2,4,8 h after operation(all P<0.05).The total pressing times of group I were significantly lower than those of group II and III in each points during 48 h after operation(P<0.05).Nausea and vomiting were not found in group I,but occurred in one patient of group II and four patients of group III(P<0.05).The incidence of other adverse reactions,such as dizziness,chills,fever,palpitation,drowsy,skin itch and so on,had no significant difference.Conclusion: Parecoxib sodium has a potent analgesic effect;the best timing might be before induction anesthesia and combination with post-operation use.更多还原