中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2010年
1期
29-32
,共4页
李锦%景龙年%张雪梅%韩如泉
李錦%景龍年%張雪梅%韓如泉
리금%경룡년%장설매%한여천
环加氧酶抑制药%镇痛
環加氧酶抑製藥%鎮痛
배가양매억제약%진통
Cyclooxygenase inhibitors%Analgesia
目的 评价颅内肿瘤切除术病人帕瑞昔布钠超前镇痛的效果.方法 择期行幕上颅内肿瘤切除术病人60例,性别不限,年龄18～60岁,体重指数<30 kg/m~2,ASA Ⅰ或Ⅱ级,随机分为2组:生理盐水组(n=30)和帕瑞昔布钠组(n=30).麻醉诱导前生理盐水组和帕瑞昔布钠组分别经2 min 静脉注射生理盐水2ml或帕瑞昔布钠加mg.术后VAS评分≥3分时行病人自控静脉镇痛(PCLA),VAS评分<3分为镇痛有效,PCIA药物为芬太尼,若PCIA仍不能满足病人术后镇痛的需求,则静脉注射芬太尼或曲马多.记录术后24 h内PCIA按压次数、有效按压次数、芬太尼用量和补救用药使用情况;术后24 h时评价恶心呕吐程度和病人对镇痛的满意度.于帕瑞昔布钠给药前和给药后2 h时测定激活凝血时间(ACT)、凝血速率(CR)和血小板功能(PF).结果 与生理盐水组比较,帕瑞昔布钠组PCIA按压次数、有效按压次数、芬太尼用量、补救用药使用率和恶心呕吐程度降低,病人对镇痛满意度升高(P<0.05),ACT、CR和PF差异无统计学意义(P>0.05).帕瑞昔布钠组给药前后ACT、CR和PF比较差异无统计学意义(P>0.05).结论 对于颅脑手术病人,麻醉诱导前给予帕瑞昔布钠可改善芬太尼PCIA的效果,产生超前镇痛作用.
目的 評價顱內腫瘤切除術病人帕瑞昔佈鈉超前鎮痛的效果.方法 擇期行幕上顱內腫瘤切除術病人60例,性彆不限,年齡18～60歲,體重指數<30 kg/m~2,ASA Ⅰ或Ⅱ級,隨機分為2組:生理鹽水組(n=30)和帕瑞昔佈鈉組(n=30).痳醉誘導前生理鹽水組和帕瑞昔佈鈉組分彆經2 min 靜脈註射生理鹽水2ml或帕瑞昔佈鈉加mg.術後VAS評分≥3分時行病人自控靜脈鎮痛(PCLA),VAS評分<3分為鎮痛有效,PCIA藥物為芬太尼,若PCIA仍不能滿足病人術後鎮痛的需求,則靜脈註射芬太尼或麯馬多.記錄術後24 h內PCIA按壓次數、有效按壓次數、芬太尼用量和補救用藥使用情況;術後24 h時評價噁心嘔吐程度和病人對鎮痛的滿意度.于帕瑞昔佈鈉給藥前和給藥後2 h時測定激活凝血時間(ACT)、凝血速率(CR)和血小闆功能(PF).結果 與生理鹽水組比較,帕瑞昔佈鈉組PCIA按壓次數、有效按壓次數、芬太尼用量、補救用藥使用率和噁心嘔吐程度降低,病人對鎮痛滿意度升高(P<0.05),ACT、CR和PF差異無統計學意義(P>0.05).帕瑞昔佈鈉組給藥前後ACT、CR和PF比較差異無統計學意義(P>0.05).結論 對于顱腦手術病人,痳醉誘導前給予帕瑞昔佈鈉可改善芬太尼PCIA的效果,產生超前鎮痛作用.
목적 평개로내종류절제술병인파서석포납초전진통적효과.방법 택기행막상로내종류절제술병인60례,성별불한,년령18～60세,체중지수<30 kg/m~2,ASA Ⅰ혹Ⅱ급,수궤분위2조:생리염수조(n=30)화파서석포납조(n=30).마취유도전생리염수조화파서석포납조분별경2 min 정맥주사생리염수2ml혹파서석포납가mg.술후VAS평분≥3분시행병인자공정맥진통(PCLA),VAS평분<3분위진통유효,PCIA약물위분태니,약PCIA잉불능만족병인술후진통적수구,칙정맥주사분태니혹곡마다.기록술후24 h내PCIA안압차수、유효안압차수、분태니용량화보구용약사용정황;술후24 h시평개악심구토정도화병인대진통적만의도.우파서석포납급약전화급약후2 h시측정격활응혈시간(ACT)、응혈속솔(CR)화혈소판공능(PF).결과 여생리염수조비교,파서석포납조PCIA안압차수、유효안압차수、분태니용량、보구용약사용솔화악심구토정도강저,병인대진통만의도승고(P<0.05),ACT、CR화PF차이무통계학의의(P>0.05).파서석포납조급약전후ACT、CR화PF비교차이무통계학의의(P>0.05).결론 대우로뇌수술병인,마취유도전급여파서석포납가개선분태니PCIA적효과,산생초전진통작용.
Objective To investigate the efficacy of preemptive analgesia with parecoxib, a novel intravenous cyclooxygenase type-2 inhibitor, far acute postoperative pain management after intracranial tumor resection.Methods Sixty ASA I or II patients of both sexes aged 18-60 yr with body mass index < 30 kg/m~2 were randomized into 2 groups ( n = 30 each) : control group (group C) and parecoxib group (group P) . In group P, parecoxib 40 mg in 2 ml of normal saline ( NS) was injected iv over 2 min before induction of anesthesia. In group C NS 2 ml was injected instead of parecoxib. Patient controlled intravenous analgesia (PCIA) with fentanyl (bolus dose 0.05 μg/kg, lockout interval 15 min, background infusion 0.2μg·kg~ (-1)·h~(-1), 24 h maximum dose 9.6μg /kg) was used after operation. The number of successfully delivered doses and the number of attempt were calculated. If PCIA did not provide satisfactory analgesia (VAS < 3) , iv bolus of fentanyl 1μg /kg or tramadol 12 mg/kg was given as rescue medication. VAS (0 = no pain, 10 = worst pain) was used to measure pain intensity and recorded at 2, 6, 12 and 24 h after operation. Patient's satisfaction, nausea and vomiting were recorded, and activated coagulation time (ACT), coagulation rate (CR) and platelet function (PF) were measured before and 2 h after parecoxib administration. Results The consumption of fentanyl, the number of successfully delivered doses and the number of attempt, the number of rescue medication administration and degree of nausea and vomiting were significantly lower while the level of patient's satisfaction was higher in group P than in group C. There was no difference in ACT, CR and PF between the two groups. Conclusion Parecoxib given before induction of anesthesia can improve the efficacy of PCIA with fentnayl and decrease side effects.
