帕瑞昔布复合舒芬太尼对椎管内肿瘤患者术后镇痛效果的临床观察

目的观察帕瑞昔布复合舒芬太尼在椎管内肿瘤患者术后患者自控镇痛（PCA）中的效果。方法择期椎管内肿瘤切除术患者90例，ASAⅠ或Ⅱ级，年龄18—60周岁，性别不限，按随机数字表法分为3组，每组30例，A组：PCA成分为舒芬太尼200μg＋生理盐水共100ml；B组：术前30min静注帕瑞昔布40mg，术后每12小时静注帕瑞昔布40mg至术后第3天，PCA成分为舒芬太尼200μg＋生理盐水共100ml；C组：帕瑞昔布应用同B组，调整PCA成分为舒芬太尼100μg＋生理盐水共100ml。镇痛泵参数设定：负荷量为2ml，持续量为1．2ml／h，PCA量为1．5ml／h，锁定时间30min。记录3组患者术后3、24、48h的疼痛视觉模拟评分（VAS），恶心呕吐、呼吸抑制等不良反应发生情况及术后48h引流量，并于镇痛治疗前后采用Sonoclot凝血与血小板功能分析仪评定两组患者的凝血功能。结果术后3、24、48h，A组患者VAS评分显著高于B、C两组（P〈0．05），但B、C两组间YAS评分比较差异无统计学意义（P〉0．05）。C组术后恶心、呕吐及头晕的发生率虽稍低于A、B两组，但差异无统计学意义（P〉0．05），三组均未发生呼吸抑制。三组镇痛治疗前后凝血功能变化比较差异无统计学意义（P〉0．05），三组术后48h引流量比较差异无统计学意义（P〉0．05）。结论帕瑞昔布复合舒芬太尼用于椎管内肿瘤患者术后镇痛效果更佳，明显减少舒芬太尼的用量和不良反应的发生，对凝血功能无影响。

Postoperative analgesia with parecoxib combined sufentanil in patients underwent intraspinal tumor surgery

Objective To compare the analgesia effect of parecoxib combined sufentanil and sufentanil alone used through intravenous postoperatively. Methods Ninety cases underwent intraspinal tumor surgery were randomly divided into three groups （ n = 30 cases per group）. Patients in group A were given sufentanil 200μg alone diluted to 100 ml via patient controlled intravenous analgesia （PCIA） after surgery. Patients in group B were administrated parecoxib 40 mg intravenously 30 minutes before the operation and every 12 h after operation for 3 days, and sufentanil 200 μg diluted to 100 ml. Patients in group C were reduced sufentanil to 100 μg compared to Group B. The PCIA rate was 1.2 ml/h, bolus 1.5 ml/h, and lock time 30 min. Analgesia and sedation grade were accessed and side effects were recorded. Coagulation and platelet function were evaluated using Sonoclot analyzer. Results The visual analogue scale （VAS） scores of 3h, 24h, and 48h after surgery in group A were significantly higher than those in group B and group C （ P 〈0. 05）. The VAS scores in group B and group C were not statistically different（ P 〉0. 05）. The incidence of side effects （ nausea and vomiting） in group C was significant lower than that in the other groups （ P 〈 0. 05 ）. There were no obvious signs of inhibition of respiration. The coagulation function and average drainage volume in the 3 groups were not statistically different. Conclusions The strategy that parecoxib combined sufentanil obtained the better analgesia effects for intraspinal tumor compared to sufentanil alone, which could get the benefits such as reduction of sufentanil dosage and adverse reaction. There were no significant effect on coagulation function with Parecoxib via PCIA.