帕瑞昔布钠对结直肠癌根治术后镇痛及肠道功能恢复的影响

目的：探讨帕瑞昔布钠联合枸橼酸芬太尼静脉自控镇痛（PCA）在结直肠癌根治术应用中的有效性和安全性.方法：随机选择2009年9月至2011年3月广东省人民医院收治的行择期结直肠癌根治术的患者90例,分为单次给药组（S组,30例）、重复给药组（M组,30例）和对照组（C组,30例）.S组：手术结束前30 min静脉注射帕瑞昔布钠40 mg,术后12 h、24h静脉注射生理盐水10 mL;M组：手术结束前30 min、术后12 h、24h静脉注射帕瑞昔布钠40 mg;C组：手术结束前30 min、术后12 h、24 h静脉注射生理盐水10 mL,术后所有患者接受PCA治疗.观察患者术后疼痛视觉模拟（VAS）评分,镇痛泵有效按压次数和枸橼酸芬太尼用量,首次排气、排便时间及空腹血浆胃动素（MTL）水平,Ramsay镇静评分,恶心呕吐发生率等指标.结果：M组患者镇痛泵有效按压次数和枸橼酸芬太尼用量显著低于S组和C组（P＜0.05）;M组患者首次排气、排便时间早于S组和C组（P＜0.05）;M组患者术后空腹MTL水平显著高于S组和C组（P＜0.05）.结论：结直肠癌根治术采用帕瑞昔布钠联合PCA镇痛,效果明确,可降低枸橼酸芬太尼的用量,患者胃肠功能恢复快.

Effects of parecoxib on postoperative analgesia and restoration of gastrointestinal function following radical colorectomy

Objective：To investigate the efficacy and safety of parecoxib sodium combined with intravenous fentanyl citrate for patient-controlled analgesia （PCA） following radical eolorcctomy. Methods： Ninety patients undergoing elective radical colorectomy were enrolled from Guangdong Provincial People＇ s Hospital between September 2009 and March 2011 and were randomly assigned to the single-dose parecoxib group （group S, n = 30 ）, repeated-dose parecoxib group （ group M, n = 30） and control group （ group C, n = 30）, respectively. For patients in group S, 40 mg parecoxib sodium was injected intravenously at 30 minutes prior to end of surgery, and 10 mL normal saline at hours 12 and 24 after surgery. For patients in group M, 40 mg parecoxib sodium was injected intravenously at 30 minutes prior to end of surgery and at hours 12 and 24 after surgery. And for patients in group C, 10 mL normal saline intravenous injection was administered at 30 minutes before end of surgery and at hours 12 and 24 after surgery. All subjects received PCA. The visual analog scale scores for pain were recorded. Other parameters, including the effective analgesic pumping, dosage of fentanyl citrate, time to first rectal gas passage or bowel movement, fasting plasma motilin level, Ramsay score and incidence rates of nausea and vomiting, were also recorded. Results：Patients in group M needed considerably less analgesic pumping and dosage of fentanyl citrate as compared with group S and group C （ both P 〈 0.05 ）. In addition to significantly higher level of fasting plasma motilin after surgery, patients in group M were also associated with shorter time to first rectal gas passage or bowel movement as compared with group S and group C （ all P 〈 0.05 ）. Conclusion： Parecoxib sodium combined with PCA is associated with ideal outcomes in terms of fewer demands for fentanyl citrate and rapid restoration of gastrointestinaX function in patients after radical colorectomy.