帕瑞昔布三剂法不同用药时机对胆囊结石术后镇痛的影响

目的探讨帕瑞昔布三剂法不同用药时机对胆囊结石术后镇痛的影响。方法采用前瞻性随机对照研究方法选取152例胆囊结石病人，根据随机数字表法分为对照组和观察组，各76例。2组均行腹腔镜胆囊切除术治疗，术后对照组采用帕瑞昔布经验给药（术后常规给药1次40 mg，病人诉切口疼痛再给药1次，1 d总药量不超过80 mg），观察组采用帕瑞昔布三剂法（术后即刻、术后8 h、术后16 h分别给药1次，每次20 mg）进行术后镇痛。对比2组术前（T₀）、术后3 h（T₁）、术后9 h（T₂）、术后18 h（T₃）血清应激相关因子去甲肾上腺素（NE）、血糖（Glu）、皮质醇（Cor）水平，疼痛程度（VAS评分），镇静情况（Ramsay镇静评分），躁动情况（Riker-SAS躁动评分），认知功能（MMSE评分），不良反应发生情况（恶心、皮肤瘙痒、呕吐、胃肠胀气、注射部位水肿），术后无痛下床时间、吗啡用量、住院时间以及住院总费用和病人满意度。结果T₁、T₂、T₃时，2组血清NE、Glu、Cor水平均较T₀时升高（P < 0.05），但观察组均低于对照组（P < 0.01）。T₁、T₂、T₃时，观察组VAS评分均低于对照组（P < 0.01）；T₁、T₂时，观察组Ramsay镇静评分高于对照组，T₃时低于对照组，差异均有统计学意义（P < 0.01）。T₁、T₂时，观察组Riker-SAS躁动评分低于对照组，T₃时高于对照组（P < 0.01）；观察组不良反应总发生率低于对照组（P < 0.05）；观察组术后无痛下床时间、住院时间均较对照组短，吗啡用量、住院总费用均较对照组少（P < 0.01）；观察组术后镇痛满意度高于对照组，差异具有统计学意义（P < 0.05）。结论帕瑞昔布三剂法能显著降低胆囊结石术后病人血清应激相关因子水平，改善镇痛镇静效果，降低不良反应发生率，促进病人术后恢复，且能减少吗啡用量及住院总费用，病人满意度高。

Influence of different time of administration of parecoxib in three doses method on postoperative analgesia of gallbladder stones

ObjectiveTo explore the effects of different time of administration of parecoxib three doses method on postoperative analgesia of gallbladder stones.MethodsOne hundred and fifty-two patients with gallbladder stones were investigated using a prospective randomized controlled study, and divided into the control group and observation group according to random number table method(76 cases in each group). Two groups were treated with laparoscopic cholecystectomy. The control group was given parecoxib empirically for 40 mg once after surgery, the patients with incision pain were given the medicine one more time, and the total dose was not more than 80 mg a day. The observation group was given parecoxib three doses method after 0 h, 8 h and 16 h of surgery, 20 mg each time for postoperative analgesia. The serum stress-related factors norepinephrine(NE), blood glucose(Glu), cortisol(Cor), pain degree(VAS score), sedationRamsay sedation score, agitation(Riker-SAS agitation score), cognitive function(MMSE score)], incidence rates of adverse reactions(including nausea, pruritus, vomiting, flatulence, edema at injection site), postoperative painless time of getting out of bed, morphine dosage, length of hospital stay, total hospitalization cost and patient's satisfaction between two groups before operation(T₀), and at postoperative 3 h(T₁), postoperative 9 h(T₂) and postoperative 18 h(T₃) were compared.ResultsAt T₁, T₂ and T₃, the serum levels of NE, Glu and Cor in two groups were higher than those at T₀(P < 0.05), but those in observation group were lower than those in control group(P < 0.01). The VAS scores in observation group at T₁, T₂ and T₃ were lower than that in control group(P < 0.01). At T₁ and T₂, the Ramsay sedation score in observation group was higher than that in control group, and lower than that at T₃(P < 0.01). The Riker-SAS agitation score in observation group at T₁ and T₂ were lower than that in control group, and which in observation group at T₃ was higher than that in control group(P < 0.01). The total incidence rate of adverse reaction in observation group was lower than that in control group(P < 0.05). Compared with the control group, the postoperative painless time of getting out of bed and hospitalization time in observation group were shorter(P < 0.01), and the amount of use morphine and total hospitalization cost in observation group were lower than those in control group(P < 0.01). The satisfaction of postoperative analgesia in observation group was higher than that in control group(P < 0.05).ConclusionsThe parecoxib three doses method can significantly reduce the serum levels of stress-related factors, improve the effect of analgesia and sedation, reduce the incidence rate of adverse reactions, promote the postoperative recovery of patients and reduce the amount of morphine and total hospitalization costs, which has high patient's satisfaction.