帕瑞昔布钠预防瑞芬太尼复合麻醉术后早期疼痛的临床应用

 目的探讨静注帕瑞昔布钠对瑞芬太尼复合麻醉术后早期疼痛和阿片类药物不良反应发生率的影响。方法选择年龄18~60 岁、ASAⅠ~Ⅱ级、拟在全身麻醉下行胃大部切除手术的患者100 例。随机分为静脉麻醉实验组（VA 组）、静脉麻醉对照组（VB 组）、吸入麻醉实验组（IA 组）和吸入麻醉对照组（IB 组）4 组。所有患者麻醉诱导均给予长托宁0.5 mg、咪达唑仑0.05mg·kg^-1、丙泊酚2 mg·kg^-1、罗库溴铵0.6 mg·kg^-1及瑞芬太尼2 ng·mL^-1靶控，术后均使用静脉患者自控止疼泵（PCA）。术中以丙泊酚4~8 mg·kg-1·min-1或七氟醚1鄄3MAC 维持麻醉。手术开始及结束前实验组分别给予帕瑞昔布钠40 mg 静注。术毕送麻醉后恢复室。记录患者苏醒拔管时间、术后1 h、2 h、4 h、6 h、12 h及24 h切口疼痛VAS 评分、PCA使用量及相关不良反应。结果IA 组与IB 组患者术后24 h各观察点VAS 评分均高于VA 组与VB 组，且术后1 h、2 h、4 h、6 h时差异有统计学意义（P <0.05），12 h仅IB组差异有统计学意义（P < 0.05）；IA组与IB组患者术后24 h各观察点阿片类药物累积用量均高于VA组与VB 组，仅24 h时，IB组药物用量差异有统计学意义（P < 0.05）。VA 组与VB 组术后24 h内各观察点的VAS 评分和阿片类累积
用量差异无统计学意义。4 组患者清醒拔管时间和术后不良反应的发生率差异无统计学意义。结论手术结束前静注帕瑞昔布钠40 mg 可降低瑞芬太尼复合麻醉手术后早期手术切口痛觉过敏，且全凭静脉麻醉较吸入麻醉能够更好的预防瑞芬太尼诱发的痛觉过敏。

Application of Parecoxib Sodium to Prevent Early Postoperative Pain in Remifentanil-based Combined Anesthesia

Objective To investigate the analgesic effect of parecoxib sodium used in remifentanil-based anesthesia with propofol or sevoflurane. Methods A total of 100 patients with ASA Ⅰ~Ⅱscheduled for elective subtotal gastrectomy were randomized divided into 2groupsgroup I and group V according to the different anesthetic maintenance regimes，and then re-divided into a treatment subgroup（A group）and a control group （B group）to receive parecoxib sodium 40 mg iv and 0.9% NS iv respectively before the end of the operation.Anesthesia for 4 groups were induced with penehyclidine hydrochloride 0.5 mg，midazolam 0.2 mg·kg^-1，propofol 2 mg·kg^-1，remifentanil with the target concentration of 2 ng·mL-1 and rocuronium 0.6 mg·kg-1 intravenously to facilitate trachea intubation. All patients were received pa-tients self-controlled analgesic pump for postoperative analgesia. Anesthesia was maintained with propofol 4-8 mg·kg-1·h-1 and sevoflurane 1-3MAC，respectively，cisatracurium 0.03 mg·kg-1 was used if necessary to keep muscle relaxation. The patients were transferred to postopera-tive anesthetic recovery room and recorded the time to extubation. Pain rates was evaluated by VAS（visual analogue scale/score）and was as-sessed at 1 h，2 h，4 h，6 h，12 h and 24 h，the cumulative volume of opioid was injected by patients-controlled analgesia pump，the opioid-
related adverse effects were also recorded. Results The pain rates was cassessed by VAS and cumulative opioid consumption in inhaled anesthesia group were obviously higher than that of intravenous anesthesia group within the first 24 hours，especially in observed time of 1 h，2h，4 h and 6 h （ P< 0.05），only patients in IB subgroup were rated higher VAS scores in 12 h time point. The cumulative opioid consumption was significantly different between inhaled anesthesia group and intravenous anesthesia group in all observed time points except the time point of 24 h when there were only patients in IB subgroup needed more opioids. There were no differences in the time to extubation and opioid-related adverse effects among all patients（ P> 0.05）. Conclusion Intraoperative administration of parecoxib sodium 40 mg before end of the operation could relieve the remifentanil-induced hyperalgesia，total intravenous anesthetic regimen could provide better prevention of the hyperalgesia.