CAJ | 학술논문

目的评价帕瑞昔布对剖宫产术后病人不同剂量吗啡硬膜外镇痛效果的影响.方法择期行剖宫产手术的病人300例,ASA分级Ⅰ或Ⅱ级,年龄20～40岁,体重54 ～ 89 kg,采用随机数字表法,将其随机分为6组(n＝50):帕瑞昔布联合常规剂量吗啡PCEA组(P1组)、帕瑞昔布联合中剂量吗啡PCEA组(P2组)、帕瑞昔布联合小剂量吗啡PCEA组(P3组),3组各设置生理盐水联合吗啡PCEA对照组(C1组、C2组和C3组).于手术结束时P1组、P2组和P3组静脉注射帕瑞昔布40 ng,C1组、C2组和C3组给予等容量生理盐水.6组术后行吗啡PCEA,C1组和P1组:负荷量为吗啡2.0mg,镇痛泵药物为吗啡3.0 mg;C2组和P2组:负荷量为吗啡1.5mg,镇痛泵药物为吗啡2.0 mg;C3组和P3组:负荷量为吗啡1.0 mg,镇痛泵药物为吗啡1.5 mg;负荷量中均加入0.15％罗哌卡因8ml,所有镇痛泵中药物均加入罗哌卡因150 mg、格拉司琼3 mg和地塞米松5 mg,用生理盐水稀释至100 ml,背景输注速率2 ml/h,PCA量0.5ml,锁定时间15 min.分别记录术毕～术后24h期间静息状态及活动状态时镇痛有效情况,记录恶心呕吐、皮肤瘙痒、呼吸抑制、低血压和嗜睡等不良反应的发生情况.结果与C1组或G2组比较,P1组或P2组术后活动状态和静息状态镇痛有效率差异无统计学意义(P＞0.05)；与C3组比较,P3组活动状态镇痛有效率升高(P<0.01),静息状态镇痛有效率差异无统计学意义(P＞0.05).与P1组和P2组比较,P3组恶心呕吐程度和皮肤瘙痒发生率降低(P<0.01),无一例病人发生呼吸抑制、低血压和嗜睡.结论静脉注射帕瑞昔布40 mg可增强剖宫产术后小剂量吗啡硬膜外镇痛的效果,而对中等剂量或常规剂量吗啡硬膜外镇痛效果无影响.
목적 평개파서석포대부궁산술후병인불동제량마배경막외진통효과적영향.방법 택기행부궁산수술적병인300례,ASA분급Ⅰ혹Ⅱ급,년령20～40세,체중54 ～ 89 kg,채용수궤수자표법,장기수궤분위6조(n＝50):파서석포연합상규제량마배PCEA조(P1조)、파서석포연합중제량마배PCEA조(P2조)、파서석포연합소제량마배PCEA조(P3조),3조각설치생리염수연합마배PCEA대조조(C1조、C2조화C3조).우수술결속시P1조、P2조화P3조정맥주사파서석포40 ng,C1조、C2조화C3조급여등용량생리염수.6조술후행마배PCEA,C1조화P1조:부하량위마배2.0mg,진통빙약물위마배3.0 mg;C2조화P2조:부하량위마배1.5mg,진통빙약물위마배2.0 mg;C3조화P3조:부하량위마배1.0 mg,진통빙약물위마배1.5 mg;부하량중균가입0.15％라고잡인8ml,소유진통빙중약물균가입라고잡인150 mg、격랍사경3 mg화지새미송5 mg,용생리염수희석지100 ml,배경수주속솔2 ml/h,PCA량0.5ml,쇄정시간15 min.분별기록술필～술후24h기간정식상태급활동상태시진통유효정황,기록악심구토、피부소양、호흡억제、저혈압화기수등불량반응적발생정황.결과 여C1조혹G2조비교,P1조혹P2조술후활동상태화정식상태진통유효솔차이무통계학의의(P＞0.05)；여C3조비교,P3조활동상태진통유효솔승고(P<0.01),정식상태진통유효솔차이무통계학의의(P＞0.05).여P1조화P2조비교,P3조악심구토정도화피부소양발생솔강저(P<0.01),무일례병인발생호흡억제、저혈압화기수.결론 정맥주사파서석포40 mg가증강부궁산술후소제량마배경막외진통적효과,이대중등제량혹상규제량마배경막외진통효과무영향.
Objective To evaluate the effects of parecoxib on efficacy of patient-controlled epidural analgesia(PCEA) with different doses of morphine after cesarean section.Methods Three hundred ASA Ⅰ or Ⅱ parturients at full term aged 20-40 yr weighing 54-89 kg undergoing elective cesarean section were randomly divided into 3 morphine groups-regular,median and small dose (groups Ⅰ,Ⅱ[ and Ⅲ) ( n ＝ 100 each).Each group was further divided into 2 subgroups ( n ＝ 50 each):parecoxib group (groups P1.2.3 ) and control group (groups C1,2.3 ).In groups P1.2.3 psrecoxib 40 mg was administered iv at the end of operation while in groups C1.2.3 normal saline (NS) was administered instead of parecoxib.Groups Ⅰ,Ⅱ and Ⅱ received a loading dose of morphine 2.0/1.5/1.0 mg+ 0.15％ ropivacaine 8 ml respectively.The PCEA solution contained morphine 3.0/2.0/1.5mg+ ropivacaine 150 mg + granisetron 3 mg+ dexamethasone 5 mg in 100 ml of NS in groups Ⅰ,Ⅱ,and Ⅲ respectively.PCEA pump was set up with a background infusion of 2 ml/h,and a bolus dose of 0.5 ml with a lockout-interval of 15 min.VAS was used to assess intensity of pain (0 ＝ no pain,10 ＝ worst pain).VAS score ≤4 was considered as effective analgesia.Adverse effects including nausea and vomiting and pruritus were recorded.Results There was no significant difference in the rate of effective analgesia between groups P1,P2 and C1,C2 The rate of effective analgesia during movement was significant higher in group P3 than in group C3.The incidence of nausea and vomiting and pruritis were significantly lower in group P3 than in groups P1 and P2.Conclusion Parecoxib can enhance the efficacy of PCEA with small dose of morphine.