术前使用帕瑞昔布钠对神经外科手术术后镇痛及凝血功能的影响

Effects of preoperative application of parecoxib on postoperative analgesia and coagulation function in neurosurgical patients

中文关键词: 帕瑞昔布钠  舒芬太尼  术后镇痛  凝血功能  神经外科手术

英文关键词: Parecoxib  Sufentanil  Postoperative analgesia  Coagulation function  Neurosurgery

中文摘要:

      目的 观察术前使用帕瑞昔布钠对神经外科手术术后镇痛及凝血功能的影响。方法 择期全麻下神经外科开颅患者90例,按照随机数表法,均分为两组:帕瑞昔布组钠(P组)和对照组(C组)。P组在手术开始前30 min静脉注射帕瑞昔布钠40 mg,C组在手术开始前30 min静脉注射生理盐水5 ml。两组术后均采用舒芬太尼静脉自控镇痛(PCIA)。PCIA配方为舒芬太尼2 μg/kg+托烷司琼0.2 mg/kg,加生理盐水至120 ml。记录两组患者术后2、4、16、24、48 h的VAS评分、Ramsay评分,术后48 h内PCIA总按压次数及有效按压次数,于帕瑞昔布钠给药前和给药后2 h、48 h测定凝血功能,并观察术后不良反应发生情况。结果 C组术后2、4、16、24、48 h VAS评分明显高于P组(P＜0.05),术后2 h P组镇静满意率明显高于C组(P＜0.05)。静脉注射帕瑞昔布钠前和注射2 h及48 h后,两组各凝血指标差异无统计学意义;术后48 h内,C组总不良反应发生率明显高于P组(P＜0.05)。结论 静脉注射帕瑞昔布钠40 mg用于神经外科术后镇痛可增强舒芬太尼PCIA的镇痛效应,减少不良反应发生率,同时不影响凝血功能。

英文摘要:

      Objective To investigate effects of preoperative application of parecoxib on postoperative analgesia and coagulation function in neurosurgical patients. Methods A total of 90 patients (38 males and 52 females, ASA physical status Ⅰ or Ⅱ) undergoing crainotomy were randomly divided into two groups (n=45): parecoxib group (group P) and control group (group C). At 30 min before operation, group P received intravenous injection of parecoxib 40 mg (5 ml), group C intravenous injection of saline 5 ml. Postoperative patient controlled intravenous analgesia (PCIA) was performed in all patients. PCIA formula of sufentanil 2 μg/kg+tropisetron 0.2 mg/kg, were diluted with normal saline to 120 ml. The visual analogue scale (VAS), the total and effective PCIA pump compressions, Ramsay sedation scale of 2, 4, 16, 24, 48 h after operation were recorded. Coagulation function was measured before and 2 h, 48 h after parecoxib administration. Meanwhile, adverse reactions were recorded. Results Comparion of VAS between the two groups was made within 48 h after surgery, the total and effective PCIA pump compressions, were much more in group C than in group P (P＜0.05). Ramsay sedation scale of group C was higher than that in group P at 2 h after operation. There were no significant differences in coagulation function. And the percentage of patients′ adverse effects in group P was lower than that in group C (P＜0.05). Conclusion Parecoxib, as an analgesic, can enhance analgesic effect of sufentanil PCIA. Not only does it reduce the amount of sufentanil and incidence of adverse reactions, but also it has no significant effect on blood coagulation function.