乳腺癌根除术中联合应用帕瑞昔布钠与地佐辛超前镇痛的临床效果

目的：评价乳腺癌根除术中联合应用帕瑞昔布钠与地佐辛超前镇痛的临床效果。 方法：将170例行乳腺癌根除术的患者分为对照组、超前镇痛组、联合超前镇痛组，分别于麻醉诱导前注射生理盐水、帕瑞昔布钠、帕瑞昔布钠+地佐辛。记录患者术后2、6、12、24、48 h的视觉模拟评分（VAS），比较各组的镇痛效果，并比较各组心血管反应与不良反应的发生情况。 结果：超前镇痛与联合超前镇痛组术后各时间点VAS评分均明显低于对照组（均P<0.05），联合超前镇痛组术后2 h的VAS评分明显低于超前镇痛组（P<0.05），术后6~48 h各时间点VAS评分虽仍低于超前镇痛组，但差异无统计学意义（均P>0.05）。诱导开始前至手术结束，超前镇痛与联合超前镇痛组的心率（HR）与平均动脉压（MAP）均低于对照组，且在插管后5 min至手术结束时明显低于对照组（均P<0.05），但两个超前镇痛组间无统计学差异（均P>0.05）。超前镇痛与联合超前镇痛组不良反应发生率均明显小于对照组（均P<0.05），联合超前镇痛组恶心、呕吐、头晕的发生率大于超前镇痛组，但差异无统计学意义（P>0.05）。 结论：帕瑞昔布钠和地佐辛联合应用于乳腺癌根除术超前镇痛临床效果良好，不会引发患者心血管反应的增多，但会可能增加患者呕吐恶心、头晕等不良反应。

Clinical efficacy of preemptive analgesia with combination use of parecoxib sodium and dezocine in radical mastectomy

Objective: To investigate the clinical efficacy of preemptive analgesia with combination use of parecoxib sodium and dezocine in radical mastectomy. Methods: One-hundred and seventy patients undergoing radical mastectomy were divided into control group, preemptive analgesia group and combined preemptive analgesia group, and were injected with normal saline, parecoxib sodium or parecoxib sodium plus dezocine before anesthesia induction, respectively. The visual analog scale (VAS) scores of the patients were recorded at postoperative 2, 6, 12, 24, and 48 h for comparing the analgesic effects among the groups, and the cardiovascular responses and incidence of adverse reactions were also compared among groups. Results: The VAS score in preemptive analgesia group or combined preemptive analgesia group was significantly lower than that in control group at any predefined time point (all P<0.05), which in combined preemptive analgesia group was significantly lower than that in preemptive analgesia group at postoperative 2 h (P<0.05), and still lower than that in preemptive analgesia group at postoperative 6 to 48 h, but did not reach statistical significance (all P>0.05). The heart rate (HR) and mean arterial pressure (MAP) of patients in both preemptive analgesia group and combined preemptive analgesia group were lower than those in control group before the induction of anesthesia to completion of operation, and were significantly lower than those in control group from 5 min after endotracheal intubation to completion of operation (all P<0.05), while no significant difference was observed between the two preemptive analgesia groups (all P>0.05). The incidence of adverse reactions in either preemptive analgesia group or combined preemptive analgesia group was significantly lower than that in control group (both P<0.05), and incidence of nausea, vomiting and dizziness in combined preemptive analgesia group was higher than that in preemptive analgesia group, but no statistical significance was reached (P>0.05). Conclusion: Preemptive analgesia of parecoxib sodium plus dezocine has good clinical efficacy in radical mastectomy, which may not cause the increase of cardiovascular response, but probably increase the incidence of nausea, vomiting and dizziness.