帕瑞昔布钠对下肢骨折内固定取出术后镇痛及应激反应的影响

目的探讨预注帕瑞昔布钠对下肢骨折内固定取出术后芬太尼镇痛效果及机体应激反应的影响。方法 60例腰-硬联合麻醉下下肢骨折内固定取出术患者随机分成三组:A组在切皮前30min静注帕瑞昔布钠40mg;B组在缝皮结束时静注推帕瑞昔布钠40mg;C组不用帕瑞昔布钠。记录术后8、24hVAS疼痛评分、术后24-h芬太尼用量及术后不良反应。术前、术毕及术后第1天检测血浆皮质醇(Cor)、BG和IL-6。结果 A、B组术后8、24hVAS评分显著低于C组(P<0.05)。A、B组术后24-h芬太尼消耗量明显少于C组(0.30±0.07)mg、(0.34±0.09)mg vs.(0.43±0.08)mg](P<0.05)。C组术后第1天的Cor、Glu、IL-6均明显高于术前和术毕(P<0.05)。术后第1天,A、B组的Cor、IL-6明显低于C组(P<0.05)。三组恶心、呕吐、异常出血等不良反应均较轻。结论术前预注射帕瑞昔布钠在一定程度上能增强术后芬太尼镇痛效果,减轻手术应激反应。

Effects of parecoxib on postoperative pain and stress response in patients underwent removal of internal fixation

Objective To observe the effects of preemptive parecoxib injection injection on the fentanyl postoperative analgesia and stress reaction in the patients undergoing the removal of internal fixation.Methods Sixty patients were equally randomized to three groups of A(injected iv.parecoxib 40 mg at 30 min before operation),B(injected iv.parecoxib 40 mg at 30 min at the end of operation) and C(injected iv.normal saline as the control).Postoperative pain was evaluated with VAS at 8,24 and 48 h after surgery.The consumption of fentanyl in 24 hours and the adverse responses were recorded.Serum corticosteroid(Cor),blood glucose(BG) and interleukin-6(IL-6) were tested before,at the end of operation and on the first day after surgery.Results VAS scores were lower in groups of A and B than those in group C at 8 and 24 h after surgery(P<0.05),which were lower in group A than those in group B(P<0.05).The 24-h consumption of fentanyl was less in groups of A and B than that in group C(P<0.05).The concentrations of Cor,BG and IL-6 in group C were higher on the first day after surgery,which of Cor and IL-6 were lower in groups of A and B than those in group C(P<0.05).There were no significant differences in the adverse responses.Conclusion The preemptive analgesia with parecoxib can enhance fentanyl postoperative analgesia and reduce stress response to surgery.