帕瑞昔布提高术后静脉镇痛的安全性和有效性

目的研究帕瑞昔布减少术后静脉镇痛（PCIA）阿片类药物用量,降低PCIA不良反应,提高PCIA的安全性和有效性。方法采用随机、双盲、安慰剂对照,选取年龄18～50岁,ASAⅠ或Ⅱ级,普胸、骨科、普通外科手术患者200例,术后均采用PCIA,随机分为两组,帕瑞昔布组和对照组,随机于手术结束前30 min静脉注射帕瑞昔布40 mg或生理盐水8 ml,并于手术结束接PCA泵。记录术后12、24 h按压PCA泵次数,记录术后12、24 h患者休息和运动时的疼痛视觉模拟评分（VAS）,Ramesay镇静评分,恶心、呕吐评分,观察PCIA使用过程中发生的不良反应。结果与对照组相比,帕瑞昔布组可明显降低术后12、24 h按压PCA泵的次数（P〈0.01）,明显降低术后12、24 h患者休息和运动疼痛视觉模拟评分及恶心、呕吐评分（P〈0.01）,降低Ramesay镇静评分（P〈0.05）。结论普胸、骨科、普通外科手术结束前30 min静脉注射帕瑞昔布40 mg,可明显减少按压PCIA泵次数,降低PCIA不良反应,提高PCIA的安全性和有效性。

Parecoxib for improving safety and efficacy of postoperative intravenous analgesia

Objective To study parecoxib reduce opiods consumption of postoperative intravenous analgesia（PCIA）,reduce PCIA adverse effects,and improve PCIA safety and efficacy. Methods This was a randomized,double-blind,placebo-controlled study.Two hundred ASAⅠorⅡpatients aged 18-50 years undergoing thoracic,orthopedics and general surgery,were randomly divided into two groups： parecoxib group and control group.Thirty minutes before the end of operation,random intravenous injections of 40 mg parecoxib or 8 ml saline were given to the patients.The patients in both groups received PCIA.At the end of the surgery,PCIA pump were connected to the patients.At 12 h,24 h after the operation number pressure of PCA pump,pain visual analogue scale（VAS） under rest and exercise conditions,sedation score by ramesay and nausea vomiting score were recorded.Adverse effects occurred in the process of using PCIA were monitored.Results Comparing with the control group,at 12 h,24 h after operation the patients in the parecoxib group were statistically significant（P0.01） in reducing the PCA number pressure,pain visual analogue scale（VAS） under rest and exercise conditions,and nausea vomiting score.And Parecoxib obviously reduced the patient＇s sedation score by ramesay（P0.05）,compared with the control group. Conclusion In thoracic surgery,orthopedics surgery,and general surgery operations,intravenous injection of 40 mg parecoxib at 30 min before the end of operation can significantly reduce the PCIA number pressure,thus limit PCIA side effects,and improve PCIA safety and efficiency.