不同时点给予帕瑞昔布对妇科手术术后镇痛的影响

目的观察围术期不同时点应用帕瑞昔布对子宫切除术患者术后镇痛的不同效果。方法选择年龄25～50岁,体重45～80kg的ASA Ⅰ-Ⅱ级择期行经腹子宫切除术患者60例,分为帕瑞昔布术前组(PR组)、帕瑞昔布术后组(PO组)、对照组(CO组),每组20例。PR组在麻醉诱导前给予帕瑞昔布40 mg;PO组在关腹前30 min给予帕瑞昔布40 mg;CO组在麻醉诱导前和关腹前30min分别给予相同容积的生理盐水。分别在术后2 h、4 h、8 h、12 h、24 h、48 h进行痛觉评分,并记录各个时点曲马多的使用量、PCIA按压次数,以及出现的不良反应。结果与CO组相比,PR组和PO组术后8 h、12 h、24 h、48 h的VAS评分降低,相应时间点的曲马多用量减少(P0.05)。PR组术后24 h、48 h PCIA按压次数减少(P0.01),术后24 h镇痛满意度提高(P0.05)。PR组、PO组两组间在术后曲马多用量、PCIA按压次数、VAS评分及24 h镇痛满意度比较,差异无统计学意义。三组患者术后不良反应主要是恶心呕吐,未发现严重不良反应,三组间差异无统计学意义。结论术前或术毕时单次静脉注射帕瑞昔布40 mg,均可以减轻术后疼痛,减少曲马多的使用量,提高病人满意度,但不能减少恶心呕吐发生率。术前静脉给予帕瑞昔布未发现超前镇痛效果。

Timing of Intravenous Parecoxib Analgesia in Abdominal Hysterectomy

Objective To observe the analgesic effect of pareeoxib when it is injected to patients at different time point of abdominal hysterectomy. Methods Sixty ASA I - II patients,aged 25 to 50,weighted 45 to 80 kg,seheduled for abdominal hysterectomy were divided into three groups：the PR group received intravenous parecoxib 40 mg before induction;the PO group received intravenous pareeoxib 40 mg 30 rain before abdomen closure ; the CO group received normal saline at both time point respectively. The intensity of pain, tramadol consumption, number of unsatisfied demand,rescue medication and adverse events were all recorded at 2 h,4 h,8 h,12 h,24 h,48 h after operation. Results Compared to the CO group, postoperative pain scores （VPA） were decreased in PR and PO group with less tramadol consumption at 8 h, 12 h, 24 h,48 h after operation （ P 〈 0. 05 ）. There were fewer unsatisfied demands and improved 24 h global evaluation of postoperative analgesia in the PR group. There were no significant differences of VAS scores, trmnadol consumption ,24 h global analgesic evaluation between the PR and PO group. Adverse effects including nausea, vomiting were mild, did not differ in frequency among groups. No serious adverse events were reported. Conclusion Parecoxib administration at the end of surgery is as effective as at the beginning of surgery with regard to analgesic effect and tramadol-saving effects. There is no any trend suggesting a preemptive analgesia efficacy from preincision.