帕瑞昔布钠对妇科腹腔镜手术全麻拔管应激反应及术后镇痛影响

目的 观察在妇科腹腔镜手术中,不同时点应用个体化剂量的帕瑞昔布钠对病人全身麻醉拔管应激反应及术后镇痛等的影响,寻找更加安全有效的用药方案。方法 择期行全身麻醉下妇科腹腔镜手术病人90例,随机分为3组,各30例。对照组（C组）麻醉诱导前30 min静脉注射生理盐水5 mL,超前镇痛组（P组）麻醉诱导前30 mi n将帕瑞昔布钠按0.65 mg/kg溶于5 mL生理盐水中静脉注射,常规镇痛组（R组）术毕即刻静脉注射P组剂量的帕瑞昔布钠。观察并记录各组入手术室后各时点的平均动脉压（MAP）、心率（HR）;记录拔管后0、2、4、6、12、24 h的视觉模拟评分法（V AS）评分。结果 3组病人拔管期MAP、HR变化、合作情况和各时点镇静情况比较差异无显著性（P〉0 0.5）;与C组相比,P组、R组在术后2、4、6、12 h的VAS评分较低（t=2.58～8.74,P〈0 0.5）;与R组相比,P组在术后2、4、6、12 h的V AS评分较低（t=2 0.4～3.54,P〈0.05）。结论 在妇科腹腔镜手术中,帕瑞昔布钠具有安全、有效的超前镇痛作用,但是其对拔管期应激反应和合作情况的影响不明显。

THE EFFECTS OF PARECOXIB ON STRESS REACTION OF EXTUBATION AFTER GENERAL ANESTHESIA AND POSTOPERATIVE ANALGESIA IN PATIENTS UNDERGOING GYNECOLOGIC LAPAROSCOPIC OPERATION

Objective To observe the effects of individualized-dose parecoxib, at different time points, on stress reaction of extubation after general anesthesia and postoperative analgesia in patients undergoing gynecologic laparoscopic surgery and look for a safer and more effective medication program. Methods Ninety patients scheduled for gynecologic laparoscopic operation （GLO） under general anesthesia （GA） were evenly randomized to three groups as follows： Control group （group C）, IV normal saline （5 mL） was given 30 min before anesthesia induction; Preemptive analgesia group （group P） , received IV parecoxib sodium 0.65 mg/kg, 30 min before the induction; Routine analgesia group （group R）, the same dose of parecoxib as it used in the group P was given upon completion of surgery. Mean arterial pressure （MAP） and heart rate （HR） at different time points after the pa tients entered the operating room were recorded, and the visual analogue scale （VAS） was recorded at 0,2,4,6,12 and 24 h after extubation. Results There were no significant differences between the three groups in terms of MAP and HR, cooperation and sedation at different time points at extubation （P〉0.05）. Compared with group C, the VAS in groups P and R were lower at 2,4, 6 and 12 h after extubation （t =2.58--8.74,P〈0.05）. Compared with group R, the VAS in group P were lower at 2,4,6 and 12 h after extubation （t=2.04-3.54,P〈0.05）. Conclusion Parecoxib sodium has a safe and effective preemptive analgesic effect in gynecologic laparoscopic surgery, but its effect on stress reaction and cooperation is not obvious.