帕瑞昔布钠联合舒芬太尼对腹腔镜子宫切除术术后镇痛效果的观察

目的比较帕瑞昔布钠复合舒芬太尼与单纯应用舒芬太尼在腹腔镜子宫切除术患者术后静脉自控镇痛（PCIA）的效果。方法将ASAⅠ~Ⅱ级行腹腔镜下全子宫切除术的90例患者,随机分为三组,每组30例。A组给予生理盐水4 mL,B组和C组以帕瑞昔布钠40 mg溶于4 mL生理盐水中,分别于气腹开始前静脉注射。三组患者均于气管导管拨除后静脉接电子微量镇痛泵,A组为100 mL溶液内含舒芬太尼0.1 mg,B组为100 mL溶液内含舒芬太尼0.075 mg,C组为100 mL溶液内含舒芬太尼0.05 mg。于术后4、8、12、24、48 h随访患者,以视觉模拟评分法（VAS）进行疼痛评分,并观察恶心、呕吐、尿潴留及呼吸抑制等不良反应的发生情况。结果 B组术后4、8、12 h的VAS疼痛评分低于A、C组（P〈0.05）;B、C组恶心、呕吐以及呼吸抑制等不良反应的发生率明显低于A组（P〈0.05）。结论气腹前应用帕瑞昔布钠联合舒芬太尼静脉自控镇痛能有效缓解腹腔镜子宫切除术患者术后的切口疼痛和非切口疼痛,能减少舒芬太尼术后镇痛的用量且不增加舒芬太尼相关不良反应,能安全有效地用于此类患者的术后镇痛。

Analgesic effects of parecoxib combined with sufentanyl on postoperative intravenous analgesia in patients undergoing laparoscopic hysterectomy

Objective ] To compare the analgesic effects of sufentanyl and parecoxib （via one bolus intravenous administration） combined with sufentanyl using for patient controlled intravenous analgesia （PCIA） after laparoseopic hysterectomy. Methods ] Ninety patients, ASA I or ]I , undergoing laparoscopic hysterectomy under general anesthesia, were randomly divided into group A, B and C, thirty ones per group. To treat postoperative pain, all patients received sufentanil via PCIA after surgery respectively. Sufentanil＇ dose of group A was 0.1rag,and B was 0.075mg,and C was O.05mg. All the patients were received postoperative to visit at 4h,8h,12h, 24h and 48h respectively, meanwhile, VAS （visible analgesia score）, and the incidence of nausea, vomiting and skin itch were recorded respectively. The patients in group B and C was administered one bolus of parecoxib （40mg,diluted by 4mL N.S.）intravenously before the surgery but group A received 4mL N.S. Reslnts ] At 4, 8, 12 h after surgery, VAS in group B were significantly less than those in group A and C（P〈0.05）. the incidence of nausea, vomiting and skin itch in group A was higher than those in group B and C respectively（P〈0.05）. Conclusion ] Sufentanil combined with parecoxib could decrease dose of sufentanil, is safe and effective on analgesia after laparoscopic hysterectomy.