臂丛麻醉联合帕瑞昔布钠对上肢手术镇痛效果及应激反应的影响

目的:观察臂丛麻醉联合帕瑞昔布钠对上肢手术患者镇痛效果及应激反应的影响.方法:60例ASAⅠ -Ⅱ级上肢手术患者随机分成帕瑞昔布组(P组)和对照组(C组),每组30例,均采用肌间沟入路行臂丛神经阻滞麻醉.P组在手术前15 min静脉注射帕瑞昔布钠40 mg,C组在手术前15 min静注等量生理盐水,观察患者术前(T0)、麻醉后切皮(T1)、术中探查(T2)及缝合时(T3)的平均动脉压(MAP)、心率(HR)、脉搏氧饱和度(SpO2)、皮质醇(Cor)、白介素-6(IL-6)、视觉模拟评分(VAS)及不良反应.结果:2组患者手术时MAP、HR、Cor、IL-6及VAS较T0时均有升高(P＜0.05)；C组患者术中各时点的MAP、HR、Cor、IL-6及VAS显著高于P组(P＜0.05).结论:臂丛麻醉联合帕瑞昔布钠对上肢手术患者镇痛效果确切,并通过抑制促炎因子IL-6及皮质醇的产生,有效降低应激反应水平.

Analgesic effects of brachial plexus nerve block combined with parecoxib in patients undergoing epipodite surgery and its related stress response

Objective: To observe the analgesic effects of brachial plexus nerve block combined with parecoxib in patients undergoing epipodite surgery and its related stress response.Methods:According to the grade of ASA,60 patients with ASAⅠorⅡwere selected and randomly divided into 2 groups: the parecoxib group(P group,n=30) and the control group(C group,n=30).All patients received interscalene brachial plexus nerve block.Patients of group P received intravenous injection of parecoxi-sodium 40 mg 15 minutes earlier before surgery,and group C received intravenous injection of equivalence saline at the same time.The mean arterial blood pressure(MAP),heart rate(HR),oxygen saturation(SpO2),corticosteroid(Cor) in plasma,interleukin6(IL-6) in plasma and visual analo scale(VAS) of patients were observed before surgery(T0),at the time of skin incision under anesthesia(T1),the time of probe during surgery(T2),and at the time of suture(T3).Incidence of adverse reaction was also recorded simultaneously.Results:MAP,HR,Cor,IL-6 and VAS in two groups were significantly increased during surgery compared to T0(P< 0.05);MAP,HR,Cor,IL-6 and VAS in the C group were significantly higher than those in P group at T1,T2 and T3(P<0.05).Conclusions:Brachial plexus nerve block combined with parecoxib has significant analgesic effect,and can effectively prevent stress response by inhibiting inflammation factors IL-6 and cortisol production.