臂丛联合帕瑞昔布钠对上肢手术镇痛效果及应激反应的影响

目的观察臂丛麻醉联合帕瑞昔布钠对上肢手术患者镇痛效果及应激反应的影响。方法 60例ASAⅠ～Ⅱ级上肢手术患者随机分成帕瑞昔布组（P组）和对照组（C组）,每组30例,均采用肌间沟入路行臂丛神经阻滞麻醉。P组在术前15 min静注帕瑞昔布钠40 mg,C组在术前15 min静注等量生理盐水,观察患者术前（T0）、麻醉后切皮（T1）、术中探查（T2）及缝合时（T3）的平均动脉压（MAP）、心率（HR）、脉搏氧饱和度（SpO2）、皮质醇（Cor）、白介素-6（IL-6）、视觉模拟评分（VAS）及不良反应。结果两组患者手术时MAP、HR、Cor、IL-6及VAS较T0时均有升高,（P〈0.05）;C组患者术中各时点的MAP、HR、Cor、IL-6及VAS显著高于P组（P〈0.05）。结论臂丛麻醉联合帕瑞昔布钠对上肢手术患者镇痛效果确切,并通过抑制促炎因子IL-6及皮质醇的产生,有效降低应激反应水平。

Influence of brachial plexus nerve block combination with Parecoxib on analgesic effect and stress response in epipodite operation patients

Objective To observe the influence of brachial plexus nerve block combination with Parecoxib on analgesic effect and stress response in epipodite operation patients.Methods According to the grade of ASA,60 epipodite operation patients with ASA Ⅰ-Ⅱ were selected and randomly divided into 2 groups: the Parecoxib group(group P,n = 30) and the control group(group C,n = 30).All patients received interscalene brachial plexus nerve block.Patients of group P received intravenous Parecoxib Sodium 40 mg 15 minutes earlier before operation,and group C received intravenous equivalence saline 15 minutes at the same time.The mean arterial blood pressure(MAP),heart rate(HR),oxygen saturation(SpO2),corticosteroid(Cor) in plasma,interleukin-6(IL-6) in plasma and visual analo scale(VAS) of the patients were observed during the preoperative(T0),postanesthetic to cut skin(T1),intraoperative probe(T2),to sew up(T3) operation and the adverse reaction were recorded simultaneously.Results MAP,HR,Cor,IL-6 and VAS in two groups were significantly increased during surgery compared to T0(P < 0.05);MAP,HR,Cor,IL-6 and VAS in the group C significantly higher than those in group P at T1,T2 and T3(P < 0.05).Conclusion The effect of brachial plexus nerve block combination with Parecoxib on analgesic is significant,and can effectively prevent stress response by inhibiting promote inflammation factors IL-6 and cortisol production.