帕瑞昔布钠术前给药对拔管期应激反应和耐管的影响

目的 探讨帕瑞昔布钠超前镇痛对全麻患者拔管期应激反应和耐管的影响.方法 选择ASA Ⅰ或Ⅱ级择期行腹腔镜胆囊摘除术的全麻患者45例,采用随机双盲设计方法分成三组,每组15例,帕瑞昔布钠超前镇痛组(A组):术前30 min静注溶于2 ml生理盐水中帕瑞昔布钠40mg,术毕缝皮时予生理盐水2 ml;帕瑞昔布钠镇痛组(B组):术前30 min予生理盐水2ml,术毕缝皮时静注溶于2 ml生理盐水中帕瑞昔布钠40 mg;对照组(C组):5％复方利多卡因乳膏涂布气管导管,术前30 min、术毕缝皮时均予生理盐水2 ml.A、B组术前5％复方利多卡因乳膏涂布气管导管.记录用药前、手术结束时、拔管时患者MAP、HR和SpO2的变化以及拔管即刻患者耐管情况和拔管后疼痛VAS评分,抽血检测三组患者用药前、手术结束时、拔管时血浆皮质醇和血糖浓度.结果 A、B组在拔管时HR慢于、MAP低于C组,而A组HR慢于、MAP低于B组(P＜0.05)；在手术结束和拔管时,A、B组血糖和皮质醇浓度低于C组,而A组低于B组(P＜0.05)；在拔管即刻,A、B组耐管评分和拔管后疼痛VAS评分显著低于C组,而A组低于B组(P＜0.05).结论 帕瑞昔布钠术前应用可减少全麻术后围拔管期应激反应和耐管,其机制可能与超前镇痛有关.

Effect of preemptive analgesia with parecoxib sodium on stress response and tube tolerance during extubation

Objective To investigate the effects of preemptive analgesia with parecoxib sodium on stress response and tube tolerance during extubation.Methods Forty-five patients (ASA I or II grade) undergoing laparoscopic cholecystectomy in general anesthesia were randomly divided into three groups with 15 each. Endotracheal tubes in three groups were coated with 5% compound lidocaine cream and the patient in control group(group C) received 2 ml saline 30 min before operation and at the end of operation. The patients in group A received 40 mg parecoxib sodium intravenously 30 minutes before operation and patients in group B received 40 mg parecoxib sodium at the end of surgery. The mean arterial pressure(MAP),heart rate(HR), oxygen saturation(SpO2), status of tube tolerance, VAS, plasma cortisone and plasma glucose were recorded and compared before injection,at the end of surgery and during extubation.Results MAP and HR were significantly lower in group B and C than those in group A during extubation (P<0.05). Blood glucose and cortisone in group B and C were significantly lower than those in group A at the end of surgery and during extubation (P<0.05). Tube tolerance status and VAS scores in group A and B were significantly lower than those in group A during extubation (P<0.05).Conclusion preoperative injection of parecoxib sodium can reduce stress response and provide tube tolerance during extubation. The mechanism may be related to preemptive analgesia.