帕瑞昔布钠联合曲马多镇痛对悬雍垂腭咽成形术患者的影响

目的 观察帕瑞昔布钠联合曲马多镇痛对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者行悬雍垂腭咽成形术(UPPP)后的镇痛效果、不良反应及炎性细胞因子水平的影响。 方法 将经多导睡眠仪(PSG)监测证实的60例OSAHS患者随机分为2个组,其中实验组(T组,30例)术前予帕瑞昔布钠联合曲马多镇痛,对照组(C组,30例)术前予曲马多镇痛,2个组UPPP术后均接受曲马多患者自控镇痛。统计2个组患者术后48 h内的疼痛视觉模拟评分(VAS),救援性镇痛药用量及不良反应发生率,并检测患者围手术期血清中肿瘤坏死因子α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)和细胞间黏附因子-1(ICAM-1)等炎性细胞因子的浓度。 结果 与C组相比,T组在术后48 h内的VAS评分降低(P<0.01),救援性镇痛药量减少(P<0.05),不良反应发生率降低(P<0.05)。T组患者血清TNF-α、IL-6浓度低于C组(P<0.01或P<0.05),而IL-10、ICAM-1浓度差异无统计学意义。 结论 帕瑞昔布钠联合曲马多镇痛用于OSAHS手术治疗术后镇痛效果良好,不良反应发生率低,并在一定程度上发挥抗炎作用,是UPPP围手术期较为理想的镇痛方法。

The effects of multimodal analgesia with parecoxib sodium and tramadol on patients treated with uvulopalatopharyngoplasty.

Objective To observe the effects of multimodal analgesia with parecoxib sodium and tramadol on postoperative analgesia, incidence of adverse reactions and inflammatory factors in patients with obstructive sleep apnea-hypopnea syndrome(OSAHS)after uvulopalatopharyngoplasty(UPPP). Methods A total of 60 OSAHS cases were randomly divided the into the test group(T group, n=30, receiving parecoxib sodium and tramadol)and control group(C group, n=30, receiving tramadol only). Both groups received patient-controlled intravenous analgesia with tramadol after UPPP. Data of visual analog scale(VAS)for pain in 48 h postoperatively, rescue analgesic use and adverse reactions were collected. Inflammatory factors including TNF-α, IL-6, IL-10 and ICAM-1 were measured with ELISA. Results Lower VAS scores, less use of rescue analgesic and fewer adverse reactions were showed in T group(P<0.01, P<0.05, P<0.05). Decreased levels of TNF-α and IL-6 were found in T group(P<0.01, P<0.05), while there were no statistically significant differences in the levels of IL-10 and ICAM-1 between the two groups. Conclusion Multimodal analgesia with parecoxib sodium and tramadol can prolong the postoperative analgesia, demand less use of rescue analgesic, and cause fewer adverse reactions, which may play a positive role in the inhibition of inflammatory reaction after UPPP.