帕瑞昔布对剖宫产术后病人不同剂量吗啡硬膜外镇痛效果的影响

目的 评价帕瑞昔布对剖宫产术后病人不同剂量吗啡硬膜外镇痛效果的影响.方法 择期行剖宫产手术的病人300例,ASA分级Ⅰ或Ⅱ级,年龄20～40岁,体重54 ～ 89 kg,采用随机数字表法,将其随机分为6组(n＝50):帕瑞昔布联合常规剂量吗啡PCEA组(P1组)、帕瑞昔布联合中剂量吗啡PCEA组(P2组)、帕瑞昔布联合小剂量吗啡PCEA组(P3组),3组各设置生理盐水联合吗啡PCEA对照组(C1组、C2组和C3组).于手术结束时P1组、P2组和P3组静脉注射帕瑞昔布40 ng,C1组、C2组和C3组给予等容量生理盐水.6组术后行吗啡PCEA,C1组和P1组:负荷量为吗啡2.0mg,镇痛泵药物为吗啡3.0 mg;C2组和P2组:负荷量为吗啡1.5mg,镇痛泵药物为吗啡2.0 mg;C3组和P3组:负荷量为吗啡1.0 mg,镇痛泵药物为吗啡1.5 mg;负荷量中均加入0.15％罗哌卡因8ml,所有镇痛泵中药物均加入罗哌卡因150 mg、格拉司琼3 mg和地塞米松5 mg,用生理盐水稀释至100 ml,背景输注速率2 ml/h,PCA量0.5ml,锁定时间15 min.分别记录术毕～术后24h期间静息状态及活动状态时镇痛有效情况,记录恶心呕吐、皮肤瘙痒、呼吸抑制、低血压和嗜睡等不良反应的发生情况.结果 与C1组或G2组比较,P1组或P2组术后活动状态和静息状态镇痛有效率差异无统计学意义(P＞0.05)；与C3组比较,P3组活动状态镇痛有效率升高(P<0.01),静息状态镇痛有效率差异无统计学意义(P＞0.05).与P1组和P2组比较,P3组恶心呕吐程度和皮肤瘙痒发生率降低(P<0.01),无一例病人发生呼吸抑制、低血压和嗜睡.结论 静脉注射帕瑞昔布40 mg可增强剖宫产术后小剂量吗啡硬膜外镇痛的效果,而对中等剂量或常规剂量吗啡硬膜外镇痛效果无影响.

Effect of parecoxib on efficacy of epidural analgesia with different doses of morphine after cesarean section

Objective To evaluate the effects of parecoxib on efficacy of patient-controlled epidural analgesia(PCEA) with different doses of morphine after cesarean section.Methods Three hundred ASA Ⅰ or Ⅱ parturients at full term aged 20-40 yr weighing 54-89 kg undergoing elective cesarean section were randomly divided into 3 morphine groups-regular,median and small dose (groups Ⅰ,Ⅱ and Ⅲ) ( n ＝ 100 each).Each group was further divided into 2 subgroups ( n ＝ 50 each):parecoxib group (groups P1.2.3 ) and control group (groups C1,2.3 ).In groups P1.2.3 psrecoxib 40 mg was administered iv at the end of operation while in groups C1.2.3 normal saline (NS) was administered instead of parecoxib.Groups Ⅰ,Ⅱ and Ⅱ received a loading dose of morphine 2.0/1.5/1.0 mg+ 0.15％ ropivacaine 8 ml respectively.The PCEA solution contained morphine 3.0/2.0/1.5mg+ ropivacaine 150 mg + granisetron 3 mg+ dexamethasone 5 mg in 100 ml of NS in groups Ⅰ,Ⅱ,and Ⅲ respectively.PCEA pump was set up with a background infusion of 2 ml/h,and a bolus dose of 0.5 ml with a lockout-interval of 15 min.VAS was used to assess intensity of pain (0 ＝ no pain,10 ＝ worst pain).VAS score ≤4 was considered as effective analgesia.Adverse effects including nausea and vomiting and pruritus were recorded.Results There was no significant difference in the rate of effective analgesia between groups P1,P2 and C1,C2 The rate of effective analgesia during movement was significant higher in group P3 than in group C3.The incidence of nausea and vomiting and pruritis were significantly lower in group P3 than in groups P1 and P2.Conclusion Parecoxib can enhance the efficacy of PCEA with small dose of morphine.