CAJ | 학술논문

　　目的探讨丙泊酚复合帕瑞昔布钠在老年人腹部手术硬膜外麻醉中使用的安全性及有效性。方法择期下腹部手术老年患者80例，年龄65～80岁，随机分成单纯丙泊酚组（A 组）和丙泊酚复合帕瑞昔布钠组（B 组）。根据手术进行硬膜外阻滞成功后，分组进行静脉辅助用药，术中维持镇静 Ramsay 评分3～5分。记录入室（T0）、切皮时（T1）及手术开始后10min（T2）、30min（T3）、60min（T4）和术毕时（T5）的 MAP、HR、SpO2；记录术后1、3、6、12、24h 的切口疼痛程度（VAS 评分，0～10分）；记录牵拉反应分级例数和术后发生不良反应的例数；记录丙泊酚的总量、追加芬太尼的例数和术毕清醒时间。结果与 T0比较，T1～ T5时 MAP、HR 明显降低（P ＜0.05）；与 A 组比较，B 组术中牵拉反应和追加芬太尼的例数明显减少（P ＜0.05），术毕清醒时间明显缩短，术后12h 间内的切口疼痛程度明显减轻（P ＜0.05）。结论丙泊酚复合帕瑞昔布钠用于老年腹部手术患者硬膜外麻醉是安全、有效的，能有效地减轻术中牵拉反应的发生，对术后12h 内的切口疼痛亦有一定的镇痛效果。
　　목적탐토병박분복합파서석포납재노년인복부수술경막외마취중사용적안전성급유효성。방법택기하복부수술노년환자80례，년령65～80세，수궤분성단순병박분조（A 조）화병박분복합파서석포납조（B 조）。근거수술진행경막외조체성공후，분조진행정맥보조용약，술중유지진정 Ramsay 평분3～5분。기록입실（T0）、절피시（T1）급수술개시후10min（T2）、30min（T3）、60min（T4）화술필시（T5）적 MAP、HR、SpO2；기록술후1、3、6、12、24h 적절구동통정도（VAS 평분，0～10분）；기록견랍반응분급례수화술후발생불량반응적례수；기록병박분적총량、추가분태니적례수화술필청성시간。결과여 T0비교，T1～ T5시 MAP、HR 명현강저（P ＜0.05）；여 A 조비교，B 조술중견랍반응화추가분태니적례수명현감소（P ＜0.05），술필청성시간명현축단，술후12h 간내적절구동통정도명현감경（P ＜0.05）。결론병박분복합파서석포납용우노년복부수술환자경막외마취시안전、유효적，능유효지감경술중견랍반응적발생，대술후12h 내적절구동통역유일정적진통효과。
Objective To investigate the safety and effectiveness of propofol combined with parecoxib sodium use in epidural anesthesia for abdominal surgery in the elderly. Methods Eighty elderly patients scheduled for selective lower abdominal surgery, age 65~80 yr, were randomly divided into two groups, pure propofol group (A group) and propofol combined with parecoxib sodium (B group). After the success of the epidural block according to the result, using intravenous drug auxiliary by group, while maintaining the Ramsay sedation score among 3~5points during operation. MAP, HR and SpO2 were recorded at the time points of entering operation(T0), cutting skin(T1), 10min(T2), 30min(T3), 60min(T4) after operation and end of surgery (T5). Record the VAS value of incision pain at 1h, 3h, 6h, 12h and 24h postoperatively (0~10 points). The cases of traction reaction classification and postoperative adverse reaction were observed and recorded, and the propofol consumptions, additional cases of fentanyl and the awake time after surgery were recorded also. Results MAP and HR were increased markedly at T0 than at T1~T5(P<0.05); Comparing with group A, group B has much lower in intraoperative traction reaction and additional cases of fentanyl(P<0.05), shorter the awake time after operation, and significant more relieved the VAS value of incision pain each time point after surgery. Conclusion Propofol combined with parecoxib sodium use in epidural anesthesia for abdominal surgery in the elderly is safe and effective, it can effectively reduce intraoperative traction reaction and appear to provide better analgesia effect in 12 hours after surgery.