CAJ | 학술논문

目的：通过观察帕瑞昔布钠对下肢骨折手术患者围手术期血浆前列腺素E2( PGE2)、β-内啡肽(β-EP)水平的影响,探讨帕瑞昔布钠减轻瑞芬太尼麻醉术后急性痛的作用机制。方法：择期下肢骨折行切开复位内固定术患者60例,随机分为3组,每组20例。 A组术前30 min静脉注射(静注)0.9%氯化钠注射液(NS)10 ml；B组术前静注帕瑞昔布钠40 mg(NS稀释至10 ml)；C组术前静注帕瑞昔布钠40 mg(NS稀释至10 ml),术后每12 h静注帕瑞昔布钠40 mg,至术后48 h结束。术毕前30 min开始镇痛,配方为芬太尼15μg/kg 加入NS 100 ml,镇痛模式为负荷剂量5 ml加持续剂量2 ml/h,补救镇痛给药每次0.5 ml,锁定时间为10 min。记录3组患者性别、年龄、体质量、手术时间和瑞芬太尼用量；分别于麻醉诱导前( T1)、术毕1 h ( T2)、术后24 h( T3)、术后48 h( T4)采血,采用放射免疫分析法测定血浆β-EP、PGE2；记录术后1、12、24、48 h视觉模拟评分及术后48 h内自控镇痛泵按压次数,是否追加使用其它镇痛药和有无严重呼吸循环抑制。结果：3组患者的性别、年龄、体质量、手术时间和麻醉药用量差异均无统计学意义(P>0.05)。与A组比较,B、C组术后视觉模拟评分明显降低,其中C组自控镇痛泵所需按压次数最少、镇痛效果最好(P<0.05)。 B、C组血浆PGE2 T2、T3、T4时点均低于A组(P<0.05~P<0.01)。 C组T3和T4时点β-EP水平均较A组和B组升高(P<0.05~P<0.01)。结论：帕瑞昔布钠能增强阿片类药物镇痛效果,显著减轻瑞芬太尼麻醉下肢骨折手术后急性痛。其主要机制可能与抑制PGE2生成、增加内源性β-EP释放有关。
목적：통과관찰파서석포납대하지골절수술환자위수술기혈장전렬선소E2( PGE2)、β-내배태(β-EP)수평적영향,탐토파서석포납감경서분태니마취술후급성통적작용궤제。방법：택기하지골절행절개복위내고정술환자60례,수궤분위3조,매조20례。 A조술전30 min정맥주사(정주)0.9%록화납주사액(NS)10 ml；B조술전정주파서석포납40 mg(NS희석지10 ml)；C조술전정주파서석포납40 mg(NS희석지10 ml),술후매12 h정주파서석포납40 mg,지술후48 h결속。술필전30 min개시진통,배방위분태니15μg/kg 가입NS 100 ml,진통모식위부하제량5 ml가지속제량2 ml/h,보구진통급약매차0.5 ml,쇄정시간위10 min。기록3조환자성별、년령、체질량、수술시간화서분태니용량；분별우마취유도전( T1)、술필1 h ( T2)、술후24 h( T3)、술후48 h( T4)채혈,채용방사면역분석법측정혈장β-EP、PGE2；기록술후1、12、24、48 h시각모의평분급술후48 h내자공진통빙안압차수,시부추가사용기타진통약화유무엄중호흡순배억제。결과：3조환자적성별、년령、체질량、수술시간화마취약용량차이균무통계학의의(P>0.05)。여A조비교,B、C조술후시각모의평분명현강저,기중C조자공진통빙소수안압차수최소、진통효과최호(P<0.05)。 B、C조혈장PGE2 T2、T3、T4시점균저우A조(P<0.05~P<0.01)。 C조T3화T4시점β-EP수평균교A조화B조승고(P<0.05~P<0.01)。결론：파서석포납능증강아편류약물진통효과,현저감경서분태니마취하지골절수술후급성통。기주요궤제가능여억제PGE2생성、증가내원성β-EP석방유관。
Objective:To observe the effect of parecoxib sodium on the level of plasma prostaglandin E2 ( PGE2 ) and β-endorphine (β-EP),and to explore the mechanism related to parecoxib sodium alleviating postoperative acute pain in patients with lower limb fracture undergoing remifentanil anesthesia. Methods:Sixty inpatients undergoing lower limbs fracture were randomly assigned into 3 groups. The patients in group A received a preoperative dose of normal saline 10 ml by intravenous administration. Group B received a preoperative dose of parecoxib sodium 40 mg ( saline 10 ml ) by intravenous administration before the operation. Group C received parecoxib sodium 40 mg before the operation, and received parecoxib sodium 40 mg every 12 h till 48 h after operation. Patient controlled intravenous analgesia was started 30 min before the end of operation,with the model( load volume 5 ml,continuous infusion at 1. 5 ml/h,and bolus 0. 5 ml at locked time 10 min). Analgesia mixture was consisted of fentanyl 15 μg/kg(total volume 100 ml). Visual analogue scale was recorded at 1,12,24,48 h after the operation. Valid/invalid presses,the need for additional analgesia drug within 48 h after the operation were recorded. The concentration of PGE2 and β-EP were determined at before anesthesia induction ( T1 ) ,1 hour after the operation( T2 ) ,24 hours after the operation( T3 ) ,48 hours after the operation( T4 ) . Results:The patients among three groups were not significantly different in demographics and doses of narcotic(P>0. 05). Compared with group A,Visual analogue scale scores in group B and group C significantly decreased. Presses in Patient controlled intravenous analgesia in group C were least in three groups(P<0. 05). Plasma PGE2 in group B and C at T2,T3,T4 significantly decreased than group A(P<0. 05 to P<0. 01). Plasma β-EP in group C at T3,T4 were higher than that in group A and B(P<0. 05 to P<0. 01). Conclusions:Parecoxib sodium could heighten the effect of opioids,and significantly relieve the postoperative acute pain in patients with lower limb fracture undergoing remifentanil anesthesia. The underlying mechanism may be related to release of endogenous β-EP and inhibition of PGE2 release.