帕瑞昔布超前鎮痛對膽囊切除術麻醉的影響

郭興彩++趙懷金

[摘要] 目的 對帕瑞昔布超前鎮痛對瑞芬太尼全憑靜脈麻醉腹腔鏡膽囊切除術的麻醉用量及術后疼痛的影響進行分析探討。 方法 將該院2014年1—12月收治的93例患者隨機分為I組（對照組）、II組（超前鎮痛用藥）及III組（術后用藥鎮痛），每組31例患者，對比3組患者的疼痛程度、血漿P物質（substance P）、白細胞介素6（IL-6）及不良反應發生率。結果 3組患者術后12 h及24 h的VAS評分均明顯低于術后1 h，差異有統計學意義（P<0.05）。II組患者術后阿片類藥物使用率明顯少于I組及III組（P<0.05）。手術結束后及術后24 h，II組患者的IL-6水平明顯低于I組及III組（P<0.05）。3組患者手術前后的血漿P物質濃度及不良反應發生率差異無統計學意義（P>0.05）。 結論 對腹腔鏡膽囊切除術患者手術前靜脈注射帕瑞昔布進行超前鎮痛能有效減少術后阿片類藥物用量，抑制患者體內的IL-6的釋放，緩解患者疼痛，在臨床上值得推廣應用。

[關鍵詞] 帕瑞昔布；瑞芬太尼；腹腔鏡； 膽囊切除術

[中圖分類號] R614 [文獻標識碼] A [文章編號] 1674-0742（2015）09（a）-0001-03

The Effect of Preemptive Analgesia with Parecoxib on the Anesthesia of Cholecystectomy

GUO Xing-cai， ZHAO Huai-jin

Anesthesiology Department， Tengnan Hospital， Shandong Energy Zaozhuang Mining Group， Jining， Shandong Province， 277606 China

[Abstract] Objective To study the dosage of preemptive analgesia with Parecoxib and its effect on postoperative pain in patients undergoing laparoscopic cholecystectomy with total intravenenous anesthesia. Methods Ninety-three cases admitted in our hospital from January 2014 to December 2014 were randomly divided into group I （control group）， group II treated by drugs for preemptive analgesia and group III treated by drugs for postoperative analgesia with 31 cases in each. The pain degree， plasma substance P， interleukin 6（IL-6） and incidence of side effects were compared between the three groups. Results The VAS score in the 3 groups at 12 hours and 24 hours after operation were much lower than those at 1 hour after operation， P<0.05. The postoperative opioid drugs use rate was obviously lower in group II than that in group I and group III， P<0.05. The IL-6 level was much lower in group II than that in group I and group III at the end of surgery and at 24h after surgery， P<0.05. The difference in the plasma substance P between the 3 groups before and after operation was not statistically significant， P>0.05. No statistically significant difference was found in the incidence of side effects between the 3 groups， P>0.05. Conclusion For patients undergoing laparoscopic cholecystectomy， intravenous injection of Parecoxib before the surgery for preemptive analgesia can effectively reduce the dosage of opioid drugs used after surgery， inhibit the release of IL-6 and alleviate the pain， so it is worthy of clinical application and promotion.

[Key words] Parecoxib； Remifentanil； Laparoscope； Cholecystotomy

麻醉可以使患者在手術過程中完全無痛，但是術后還是會出現疼痛困擾。雖然，術后鎮痛能夠為患者緩解痛苦，但是疼痛治療情況仍然不太理想，約有80%患者術后會出現不同程度的疼痛[1]。帕瑞昔布鈉是靜脈用的COX-2抑制劑，具有鎮痛、消炎作用，且對腸胃功能及血小板功能的影響小。臨床上關于帕瑞昔布在腹腔鏡膽囊切除術后鎮痛雖多篇報道，但是在超前鎮痛中的應用效果還有較大爭議[2]。為了對帕瑞昔布超前鎮痛對腹腔鏡膽囊切除術中的應用價值進行分析探討，該研究對該院2014年1—12月收治的93例腹腔鏡膽囊切除術患者進行隨機對照研究，現報道如下。