帕瑞昔布钠对肝癌切除术患者肝功能及术后镇痛药物舒芬太尼用量的影响

目的探讨帕瑞昔布钠对肝癌切除术患者肝功能及术后镇痛药物舒芬太尼用量的影响。方法 36例原发性肝癌患者随机分为超前镇痛组(A组)、术后镇痛组(B组)和对照组(C组)各12例。A组于麻醉诱导前30min和12h后、B组于手术结束时和12h后分别静脉注射帕瑞昔布钠40mg;C组在手术结束时和12h后分别静脉注射生理盐水2mL。3组均采用舒芬太尼自控镇痛(patient controlled intravenous analgesia,PCIA),观察术后3组患者肝功能指标变化、舒芬太尼用量、PCIA总次数和PCIA有效次数以及术后2,4,6,12,24hVAS评分和患者镇痛满意度。结果与C组比较,给药12,24h后A,B组舒芬太尼用量减少,PCIA总次数和PCIA有效次数降低(P<0.05),术后2,4,6,12,24h VAS评分降低,术后24h镇痛满意度明显提高(P<0.01);术后即刻和术后1d3组总蛋白、白蛋白降低,谷丙转氨酶、谷草转氨酶升高,术后2～3d总蛋白、白蛋白逐渐升高,谷丙转氨酶、谷草转氨酶逐渐降低,A,B组与C组比较差异均无统计学意义(P>0.05);3组各时间点肌酐、尿素氮、血小板、凝血酶原时间、活化部分凝血活酶时间等指标无明显变化(P>0.05);A组与B组间在舒芬太尼用量、镇痛效果及术中出血量方面比较差异无统计学意义(P>0.05)。结论肝癌切除术患者使用帕瑞昔布钠可减少术后舒芬太尼用量,提高镇痛质量,且对肝功能无明显影响。

Influence of parecoxib sodium on the liver function and dosage of sufentanil in postoperative analgesia after resection of liver cancer

Objective To explore the influence of parecoxib sodium on the liver function and the dosage of sufentanil in postoperative analgesia after resection of liver cancer.Methods Thirty-six patients undergoing primary liver cancer resection were randomly divided into group A(preemptive analgesia),group B(postoperative analgesia) and group C(control group),with 12 cases in each group.Group A received 40 mg parecoxib intravenously 30 minutes before and 12 hours after anesthesia induction respectively.Group B received 40 mg perecoxib and group C received 2 mL normal saline intravenously immediately and 12 hours after the operation.Three groups received sufentanil under patient controlled intravenous analgesia(PCIA).The liver function indexes,dosage of sufentanil,total and effective times of PCIA,postoperative 2-,4-,6-,12-and 24-hour VAS scores and patient’s satisfactory degree were observed.Results Compared with group C,the dosage of sufentanil 12 and 24 hours after operation was significantly less(P<0.01),the total and effective PCIA times reduced(P<0.05),VAS scores at the different time points were significantly lower(P<0.01),and the patient’s satisfactory degree was improved(P<0.01) in group A and B.The total protein and albumin decreased,and glutamic-pyruvic transaminase and glutamic-oxaloacetic transaminase increased immediately and one day after operation in these three groups.The total protein and albumin increased gradually,glutamic-pyruvic transaminase and glutamic-oxaloacetic transaminase decreased gradually by day 2 and 3 after operation,and there were no significant differences in these three groups(P>0.05).There were no significant differences in creatinine,blood urea nitrogen,platelet,prothrombin time and activated partial thromboplastin time in different time points among these three groups(P>0.05).There were no significant differences in the dosage of sufentanil,the effect of postoperative analgesia and inteaoperative bleeding volume between group A and group B(P>0.05).Conclusion Parecoxib can reduce the dosage of sufentanil and improve postoperative analgesia with slight adverse reaction to liver function in patients undergoing liver cancer resection.