不同时间点应用帕瑞昔布钠超前镇痛对胃癌根治术老年患者术后镇痛的影响

目的 观察帕瑞昔布钠超前镇痛于不同时间点应用对胃癌根治术老年患者术后镇痛的影响,并探讨其安全性。 方法 回顾性分析本院收治的78例需行胃癌根治术老年患者临床资料,随机分为2组,观察组于麻醉诱导前静脉注射帕瑞昔布钠40 mg,对照组于手术结束时刻静脉注射帕瑞昔布钠40 mg。2组均于手术结束时衔接静脉自控镇痛泵:舒芬太尼0.8 μg/(kg·d)+昂丹司琼16 mg+地佐辛10 mg+生理盐水配置成100 ml,设置速度为2 ml/h,自控15 min,2 ml/次。比较2组手术结束时刻、术后6 h、术后24 h、术后48 h平均动脉压(MAP)及心率(HR)水平,记录2组术后不同时刻视觉模拟评分(VAS)水平及术后24 h静脉镇痛泵按压次数及舒芬太尼使用总量;统计2组不良反应发生率。 结果 观察组于手术结束时刻、术后24 h平均动脉压及心率水平均低于对照组(均P<0.05),血流动力学更为稳定;观察组术后6h、术后12 h、术后24 h、术后48 h VAS评分均低于对照组(均P<0.05);观察组24 h自控镇痛泵按压次数及舒芬太尼使用总量均低于对照组(均P<0.05);2组不良反应发生率比较差异无统计学意义(P>0.05)。 结论 帕瑞昔布钠超前镇痛麻醉前应用降低胃癌根治术老年患者术后疼痛效果显著,血流动力学稳定,且不增加不良反应,应用安全。 

Effect of preemptive analgesia with parecoxib sodium at different time-point on postoperative analgesia elderly patients undergoing radical resection of gastric cancer

Objective To observe the effect of preemptive analgesia with parecoxib sodium at different time-point on postoperative analgesia elderly patients undergoing radical resection of gastric cancer,and to evaluate the security. Methods We retrospectively analyzed the clinical data of 78 patients undergoing radical surgery in elderly patients with gastric cancer.They were randomly divided into observation group(A) and control group(B).Intravenous parecoxib sodium 40 mg was performed in Group A before the induction of anesthesia,and in the Group B at the end of operation.Then the patient-controlled intravenous analgesia pump was used in both groups at the end of the operation:Sufentanil 0.8 g/(kg·d),ondansetron 16 mg and dezocine 10 mg were configured for 100 ml with saline;Parameters:speed 2 ml/h,automatic control 15 min,2 ml/time.The mean arterial pressure(MAP) and heart rate(HR) at the end of operation,6 h,24 h and 48 h after the surgery were compared between the two groups.The visual analogue scale(VAS),pressing times of the patient-controlled intravenous analgesia pump within 24 h after the operation,and the total dose of Sufentanil were recorded.The incidence of adverse reactions of the two groups was observed. Results MAP and HR in the observation group at the end of operation and 24 h after the operation were lower than those in the control group(P<0.05),with more stable hemodynamics;VAS of the patients in the observation group at 6 h,12 h and 24 h after the operation was lower than the control group(P<0.05).The total pressing times and the total dose of Sufentanil in the observation group were lower than those in the control group(P<0.05).There was no significant difference in the incidence of adverse effects between the two groups(P>0.05). Conclusion The preemptive analgesia with parecoxib sodium before the induction of anesthesia can effective reduce the postsurgical pain in elderly patients undergoing radical resection of gastric cancer,with stable hemodynamics,lower incidence of adverse effect and good safety.