帕瑞昔布用于脊柱手术病人超前镇痛的临床研究

目的:探讨脊柱手术中帕瑞昔布术前用药对术后患者疼痛及应激反应的影响,以评价帕瑞昔布在脊柱手术中超前镇痛的临床效果。方法:选择60例择期行腰椎内固定手术的患者随机分为A(实验组)、B(对照组)、C(空白对照组)三组。A组于麻醉诱导前静注帕瑞昔布40 mg;B组于术毕静注帕瑞昔布40 mg;C组于术毕静注生理盐水5 mL,三组均于术后用芬太尼行PCIA。每组于用药前(T0)、术毕(T1)、术后6 h(T2)及术后24 h(T3)测血糖(BG)、CRP及IL-6水平。记录术后VIS的镇痛评分,并记录24 h内不良反应的发生情况。结果:(1)A组BG较B、C组术后更快恢复至术前水平,B、C组较A组术后BG波动范围更大。(2)三组患者术前CRP浓度和IL-6浓度无显著差异(P>0.05),均于术毕T1降低,T2、T3逐渐升高,与术前T0相比有差异(P<0.05);组间比较,T2、T3两个时点A组低于B组(P<0.05),B组低于C组(P<0.05)。(3)C组患者术后12h内VAS评分均高于A、B组,差别有意义(P<0.05),A组与B组在术后6 h、12 h差异有非常显著意义(P<0.01)。术后不良反应三组差异无显著意义(P>0.05)。结论:帕瑞昔布用于脊柱手术超前镇痛能明显减轻术后疼痛,提高术后镇痛满意度;帕瑞昔布用于脊柱手术超前镇痛能有效抑制术后应激反应。

The clinical research of parecoxib in the preemptive analgesia for spinal surgery

Objective To investigate the effect of parecoxib in the preemptive analgesia on postoperative pain stress response for spinal surgery,so as to evaluate the clinical effect of parecoxib in the preemptive analgesia.Methods 60 patients undergoing selective lumbar fixation operation were randomly divided into 3 groups: Group A(experimental group),B(control group)and C(blank control group),20 cases in each group.Group A were given 5ml saline and 40mg parecoxib before anesthesia;Group B were given 5ml saline and 40mg parecoxib at the end of the operation;Group C was given 5ml normal saline at the end of operation.Three groups took fentanyl PCIA after operation.Venous blood sample were taken at the time before anesthesia(T0),at the end of operation(T1),6 hours after operation(T3) and 24 hours after operation(T4) to evaluate the levels of blood glucose(BG),CRP and IL-6 respectively;VAS scores were recorded and side effects were also recorded 24 hours after the operation.Results ①Compared with Group B and Group C,the BG of Group A showed a shorter recovery time and the fluctuation of BG in Group A was the least.② There was no significant difference among the concentrations of CRP and IL-6 in three groups at T0(P>0.05).The concentrations of CRP in 3 groups descended at T1,and gradually went up at T2,T3.There was significant difference between the concentrations of CRP at T1,T2,T3 and the one at T0(P<0.05);At T1 and T2,CRP in group A were lower than that in group B(P<0.05)and CRP in group B were lower than that in group C(P<0.05).③The VAS scores of each time point within 12 hours after operation in group C wree all higher than those in group A(P<0.05)and B(P<0.01).There was significant difference(P<0.01) in VAS scores between group A and B in 6 hours and 12 hours after operation.There was no significant difference in side effect after operation among three groups(P>0.05).Conclusion Parecoxib applied before operation in the preemptive analgesia for spinal surgery can evidently relieve pain after operation and rise satisfacion of patients.Parecoxib applied before operation in the preemptive analgesia for spinal surgery can effectively reduce post-operation stress response.