丙泊酚复合帕瑞昔布钠用于老年人硬膜外麻醉的临床研究

目的探讨丙泊酚复合帕瑞昔布钠在老年人腹部手术硬膜外麻醉中使用的安全性及有效性。方法择期下腹部手术老年患者80例,年龄65～80岁,随机分成单纯丙泊酚组(A组)和丙泊酚复合帕瑞昔布钠组(B组)。根据手术进行硬膜外阻滞成功后,分组进行静脉辅助用药,术中维持镇静Ramsay评分3～5分。记录入室(T0)、切皮时(T1)及手术开始后10min(T2)、30min(T3)、60min(T4)和术毕时(T5)的MAP、HR、SpO2;记录术后1、3、6、12、24h的切口疼痛程度(VAS评分,0～10分);记录牵拉反应分级例数和术后发生不良反应的例数;记录丙泊酚的总量、追加芬太尼的例数和术毕清醒时间。结果与T0比较,T1～T5时MAP、HR明显降低(P<0.05);与A组比较,B组术中牵拉反应和追加芬太尼的例数明显减少(P<0.05),术毕清醒时间明显缩短,术后12h间内的切口疼痛程度明显减轻(P<0.05)。结论丙泊酚复合帕瑞昔布钠用于老年腹部手术患者硬膜外麻醉是安全、有效的,能有效地减轻术中牵拉反应的发生,对术后12h内的切口疼痛亦有一定的镇痛效果。

Clinical Study of Propofol Parecoxib Sodium for the Elderly with Epidural Anesthesia

Objective To investigate the safety and effectiveness of propofol combined with parecoxib sodium use in epidural anesthesia for abdominal surgery in the elderly. Methods Eighty elderly patients scheduled for selective lower abdominal surgery, age 65-80 yr, were randomly divided into two groups, pure propofol group （A group） and propofol combined with parecoxib sodium （B group）. After the success of the epidural block according to the result, using intravenous drug auxiliary by group, while maintaining the Ramsay sedation score among 3-5points during operation. MAP, HR and SpO2 were recorded at the time points of entering operation（T0）, cutting skin（Tl）, 10min（T2）, 30min（T3）, 60min（T4） after operation and end of surgery （Ts）. Record the VAS value of incision pain at 1h, 3h, 6h, 12h and 24h postoperatively （0-10 points）, The cases of traction reaction classification and postoperative adverse reaction were observed and recorded, and the propofol consumptions, additional cases of fentanyl and the awake time after surgery were recorded also. Results MAP and HR were increased markedly at TO than at T1-T5（P〈0.05）; Comparing with group A, group B has much lower in intraoperative traction reaction and additional cases of fentanyl（P〈0.05）, shorter the awake time after operation, and significant more relieved the VAS value of incision pain each time point after surgery. Conclusion Propofol combined with parecoxib sodium use in epidural anesthesia for abdominal surgery in the elderly is safe and effective, it can effectively reduce intraoperative traction reaction and appear to provide better analgesia effect in 12 hours after surgery.