麻醉诱导前帕瑞昔布钠对肝病患者术后镇痛效果及凝血功能的影响

目的观察并分析肝炎肝硬化脾切除术应用帕瑞昔布钠超前镇痛的术后镇痛效果及凝血功能变化。方法选取行肝炎肝硬化门脉高压症脾切除加贲门周围血管离断术患者86例,采用随机数字表法将患者分为2组,其中观察组46例,对照组40例,2组患者给予常规麻醉诱导及麻醉维持,其中观察组麻醉诱导前10min给予帕瑞昔布钠40mg(将其溶于2mL质量浓度为9g·L~(-1)的氯化钠溶液)静脉注射进行超前镇痛,对照组给予质量浓度为9g·L~(-1)的氯化钠溶液2mL静脉注射,观察2组术后自控镇痛泵应用情况、不良反应及凝血功能各指标差异。结果观察组患者术后24h内自控镇痛泵按压次数、有效按压次数及舒芬太尼用量均低于对照组,术后24h内恶心、呕吐等不良反应发生率低于对照组(P<0.05)。观察组和对照组麻醉前及术后12h凝血酶原时间(PT)、凝血酶时间(TT)、血小板计数(Plt)和纤维蛋白原质量浓度(Fib)等指标差异无统计学意义。结论肝炎肝硬化患者术前应用帕瑞昔布钠超前镇痛对患者术后镇痛效果明显,能够有效减少术后阿片类药物用量,减少患者不良反应发生率,对患者凝血功能无明显影响。

Effect of parecoxib sodium before anesthesia on analgesic and coagulation function in patients after liver disease

Objective To observe and analyze the effect of parecoxib sodium on analgesic effect and the changes of coagulation func-tion in hepatitis cirrhosis.Methods 86 cases of hepatitis cirrhosis portal hypertension spleen resection plus pericardia vascular dis-connection patients were divided into 2 groups,the observation group (46 cases)and the control group (40 cases).2 groups of pa-tients were given routine anesthesia induction and maintenance of anesthesia,in which the observation group for 10 min before in-duction of anesthesia were given 40 mg parecoxib sodium (which was dissolved in 2 mL of 9 g·L-1 sodium chloride solution)in-travenously for preemptive analgesia.Patients in the control group were given 9 g · L-1 sodium chloride solution 2 mL intrave-nously.The 2 groups were observed with regard to the postoperative patient controlled analgesia pump application,adverse reac-tions and coagulation function.Results In the observation group after 24 h the patient-controlled analgesia pump pressing times,ef-fective pressing numbers and sufentanil consumption were lower than the control group,postoperative 24 h of nausea and vomiting in adverse reactions occurred were lower than that in the control group (P<0.05).In the observation group and control group be-fore anesthesia and postoperative 12 h,the prothrombin time (PT),thrombin time (TT),platelet count (Plt),fibrinogen concen-tration (Fib)and other indicators were not statistically different.Conclusion Hepatitis cirrhosis patients with preoperative applica-tion of parecoxib preemptive analgesia could effectively reduce the postoperative opioid drug dosage,reduce the incidence of adverse reactions but on coagulation function,no obvious effect was observed.