帕瑞昔布钠预注对腹腔镜胆囊切除术后镇痛效果的影响

目的探讨帕瑞昔布钠预先注入对腹腔镜胆囊切除术患者术后镇痛效果的影响。方法选择腹腔镜下胆囊切除术患者80例,ASAⅠ～Ⅱ级,随机分为帕瑞昔布钠超前镇痛组（A组）和帕瑞昔布钠术后镇痛组（B组）,每组40例。所有患者均采用静吸复合全身麻醉。两组患者分别在麻醉诱导前和手术结束时静注帕瑞昔布钠40mg,术毕拔管清醒后均采用芬太尼1.0μg/kg用于术后镇痛。采用VAS评分法评估患者术后0、1、2、4、8、12、24h疼痛程度并记录需追加芬太尼镇痛患者的时间间隔及追加次数;记录手术时间、麻醉苏醒时间及不良反应等情况。结果 A组患者在术后0、1、2、4、8、12、24hVAS评分均低于B组（P〈0.05）,且术后24h内需追加芬太尼镇痛的患者明显少于B组（P〈0.05）。两组患者手术时间、麻醉苏醒时间及不良反应发生率差异无统计学意义（P〉0.05）。结论帕瑞昔布钠超前镇痛可以产生较好的术后镇痛效果,同时可减少阿片类药物的应用。

Efficacy of paracoxib for preemptive analgesia after laparoscopic cholecystectomy

Objective To evaluate effects of parecoxib for preemptive analgesia in patients under-going laparoscopic cholecystectomy （LC）.Methods Eighty patients undergoing LC were randomly divided into two groups：A and B.Patients in Group A （n=40） received parecoxib 40mg before induction：patients in Group B （n=40） received the same doses after skin closure.A standardized general anesthetic was used.All patients were started on fentanil （i.v.1.0μg/kg） analgesia when awake after tracheal extubation.The effectiveness was assessed postoperatively using the visual analogue scale （VAS） at 0、1、2、4、8、12、24hours after surgery,and by calculating the total analgesic consumption of fentanil in the first 24 hours following operation.Time to first analgesic request,vital signs and side effects were also recorded.Results Patients in group A reported significantly lower pain scores（P0.05）at all time intervals compared to group B.There were significantly fewer patients in the preemptive group than comparative group who required rescue analgesic with in the first 24 hours （P0.05）.Mean time to first analgesic request was also significantly longer in the preemptive group （P0.05）.Conclusion Parecoxib administered preemptively appears to improve the quality of postoperative analgesia and lead to reduced consumption of opioid analgesics postoperatively in patients undergoing LC.