摘要
目的评价帕瑞昔布钠联合硬膜外吗啡用于妇科手术病人多模式术后镇痛的效果。方法随机、双盲、安慰剂对照、多中心、前瞻性研究。择期脊椎．硬膜外联合阻滞下行妇科开腹手术病人240例，性别不限，年龄18～64岁，ASA分级Ⅰ或Ⅱ级。采用随机数字表法，将病人随机分为2组：对照组（c组）和帕瑞昔布钠组（P组）。于手术开始前30min，C组和P组分别静脉注射生理盐水2ml或帕瑞昔布钠40mg，给药后12、24和36h时再静脉注射生理盐水2ml或帕瑞昔布钠40mg。2组均采用吗啡PCEA，术后维持VAS评分≤3。当VAS评分〉4分时，静脉注脉曲马多作为补救镇痛用药。记录术后48h内PCEA总按压次数和有效按压次数、吗啡用量、补救药使用情况；术后48h时记录病人对镇痛的总体满意度评分，取血样，测定血清Cr、BUN、ALT、AST、总胆红素水平和凝血功能，记录各指标异常的发生情况；记录术后48h内不良反应（恶心、呕吐、瘙痒）的发生情况和胃肠功能恢复情况。结果共完成225例，其中P组112例，C组113例。与C组比较，P组PCEA总按压次数和有效按压次数、吗啡用量和补救用药率降低，病人对镇痛总体满意度评分升高，术后呕吐发生率降低（P〈0．05或0．01）；2组恶心和瘙痒发生率、胃肠功能恢复情况以及肝肾功能和凝血功能指标异常发生率比较差异无统计学意义（P〉0．05）。结论帕瑞昔布钠联合硬膜外吗啡可安全有效地用于妇科手术病人术后多模式镇痛，同时还可降低吗啡用量，减免吗啡的副作用。
Objective To evaluate the efficacy of parecoxib sodium combined with epidural morphine for multi-mode analgesia after gynecologic operation in a randomized, double-blind, placebo-controlled, multicenter, prospective study. Methods Two hundred and forty ASA Ⅰ or II female patients, aged 18-64 yr, scheduled for elective gynecologic operation under combined spinal-epidural anesthesia, were randomly divided into 2 groups： control group （group C） and parecoxib sodium group （group P）. Normal saline 2 ml or parecoxib sodium 40 mg was injected intravenously 30 min before the start of operation and was injected again 12, 24 and 36 h later. Pa- tient-controlled epidural analgesia with morphine was used for postoperative analgesia in both groups. VAS score was maintained ≤ 3 after operation. When VAS score 〉 4, tramadol was injected as rescue analgesic. The number of attempts, the number of successfully delivered doses, the amount of morphine used, requirement for the rescue analgesic within 48 h after operation and patient＇ s satisfaction at 48 h after operation were recorded. Blood samples were taken at 48 h after operation for determination of serum creatinine （Cr）, blood urea nitrogen （BUN）, alanineaminotransferase （ALT）, aspartate transaminase （AST）, total bilirubin levels and coagulation function. The ab- normality in the parameters was recorded. The adverse effects （nausea, vomiting, pruritus） and recovery of gas- trointestinal function were recorded within 48 h after operation. Results Of the 225 patients who completed the study, there was 112 cases in group P and 113 cases in group C. Compared with group C, the number of attempts, the number of successfully delivered doses, amount of morphine used and requirement for the rescue analgesic were significantly decreased, the satisfaction score was increased and the incidence of postoperative vomiting was de- creased in group P （ P 〈 0.05 or 0.01）. There was no significant difference in the incidence of nausea and pruri- tus, recovery of gastrointestinal function, and abnormality in the parameters of liver and kidney functions and coag- ulation function between the two groups （ P 〉 0.05 ） . Conclusion Parecoxib sodium combined with epidural mor- phine can be safely and effectively used for multi-mode analgesia after gynecologic operation and reduce the requirement for morphine and side effects of morphine.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2012年第11期1293-1296,共4页
Chinese Journal of Anesthesiology
关键词
环氧化酶2抑制剂
吗啡
镇痛
硬膜外
妇科外科手术
Cyclooxygenase2 inhibitors
Morphine
Analgesia, epidural
Gynecologic surgical pro- cedures
