【摘要】 目的观察帕瑞昔布钠超前镇痛对腹部手术患者围术期应激反应和术后镇痛的影响。方法选择美国麻醉医师协会(ASA)Ⅰ~Ⅱ级行腹部手术患者100例,随机观察组和对照组,每组50例。两组患者分别在术前30 min单次肌肉注射帕瑞昔布钠40 mg和相同容积的0.9%氯化钠注射液2 m L。两组患者分别在注射前10 min(T1)、手术开始后30 min(T2)、60 min(T3)、术毕即刻(T4)及术后6 h(T5)、12 h(T6)抽取静脉血样,测定各时点肾上腺素(E)、去甲肾上腺素(NE)、皮质醇(Cor)、促肾上腺皮质激素(ACTH)的血浆浓度。结果与对照组比较,观察组在T2及T3时点血浆E和NE浓度显著降低(P<0.01),在T2,T3,T4时点血浆Cor浓度显著降低(P<0.01),在T2,T3,T 4,T5时点血浆ACTH浓度显著降低(P<0.01)。与对照组比较,观察组在术后1,2,6,12,24 h疼痛视觉模拟评分(VAS)降低(P<0.05)。结论腹部手术前预先给予帕瑞昔布钠可产生良好的超前镇痛效果,减少手术患者围术期应激激素的释放,提高术后镇痛质量,有利于术后恢复。更多还原

【Abstract】 Objective To investigate the effect of parecoxib sodium preemptive analgesia on the perioperative stress response and postoperative analgesia in the patients with abdominal surgery. Methods 100 ASAI class Ⅱ cases of abdominal surgery were selected and randomly divided into two groups: the study group( parecoxib sodium) and the control group( normal saline), 50 cases in each group. The two groups were respectively given parecoxib sodium 40 mg and the same volume of normal saline 2 m L by intramuscular injection at preoperative 30 min. The venous blood samples were collected for detecting the plasma concentrations of epinephrine( E),norepinephrine( NE),cortisol( Cor),adrenocorticotropic hormone( ACTH) before injection of parecoxib sodium or normal saline( T1),at30 min( T2),60 min( T3) after the operation beginning, immediately after surgery end( T4), and at postoperative 6 h( T5),12 h( T6).Results The changes of the stress response parameters: compared with the control group, plasma E and NE concentrations at T2, T3 were significantly decreased,and the difference was statistically significant( P < 0. 01); plasma Cor concentrations at T2,T3,and T4 were significantly decreased,and the difference was statistically significant( P < 0. 01); plasma ACTH concentrations at T2,T3,T 4,T5 in the study group were significantly decreased compared with the control group,and the difference was statistically significant( P < 0. 01). The postoperative Visual Analogue Scale( VAS) score results: compared with the control group,the VAS scores at postoperative 1,6,12,24 h in the study group were decreased, and the differences had statistical significance( P < 0. 05). Conclusion Giving parecoxib sodium in advance before abdominal operation can produce better preemptive analgesic effect,reduces the release of perioperative stress hormones,improves the quality of postoperative analgesia and conduces to postoperative rehabilitation.更多还原