帕瑞昔布钠超前镇痛对妇科腹腔镜手术全凭静脉麻醉效果的影响

目的:评价帕瑞昔布钠超前镇痛对妇科腹腔镜手术异丙酚-芬太尼静脉麻醉效果的影响。方法:选择在我院行妇科腹腔镜手术的患者60例,ASA分级为Ⅰ级或Ⅱ级,年龄分布在21-53岁,体重为41-72 kg。将所有患者随机分为帕瑞昔布钠组(P组)和生理盐水组(NS组),每组各30例。在麻醉诱导前15 min,对P组患者采取静脉注射帕瑞昔布钠40 mg,NS组患者则采取静脉注射等容积的生理盐水。两组麻醉诱导方法相同,术中以脑电双频指数(bispectral index,BIS)为麻醉深度指标,根据BIS值调节异丙酚血浆靶浓度以维持麻醉。记录拔管期间患者的心率(HR),平均动脉压(MAP)变化情况,苏醒时间,拔管时间,苏醒期不良反应及拔管后5 min疼痛VRS评分。结果:①两组患者血流动力学平稳,P组在T3至T6各时点的MAP和T3至T5各时点的HR均明显低于NS组,差异有统计学意义(P0.05);②两组苏醒时间和拔管时间无明显差别(P0.05);P组苏醒期躁动发生率为10%,明显低于NS组的26.7%,差异有统计学意义(P0.05);③P组拔管后5 min疼痛VRS评分为2.0,明显低于NS组的3.6,差异有统计学意义(P0.05)。结论:帕瑞昔布钠超前镇痛能减轻异丙酚-芬太尼静脉麻醉下妇科腹腔镜手术过程中血流动力学波动,减少苏醒期躁动的发生和疼痛VRS评分。

The Effect of Parecoxib Sodiumon the Intravenous Anesthesia with Propofol-fentanyl of Gynecological Laparoscopic Surgery

Objective： To evaluate the effect ofparecoxib on intravenous anesthesia with propofol-fentanyl of patients undergoing gynecological laparoscopic surgery. Methods： Sixty patients （ASA Ⅰ or Ⅱ, 21053 years old, 41-72kg） who were undergoing gynecologi- cal laparoscopic surgery were selected and randomly divided into two groups： parecoxib group （group P） who were received intravenous parecoxib sodium and group NS who were received normal 0 mL before anesthesia induction for 15 min, 30 cases of each group. The same anesthetic induction method was used in the two groups. Bispectral index （BIS） was used as the index of depth of anesthesia, by which the target plasma concentration ofpropofol was adjusted to maintain the anesthesia. HR, MAP were recorded, recovery time, extu- bation time, the incidence of postoperative adverse reactions and VRS after extubation for five min were recorded. Results： ①Compared with group NS, MAP at T3 to T6, HR at T3 to T5 in group P were lower, and there were statistically significant difference between two groups（P〈0.05）;②The recovery time and extubation time showed no differences between group P and group NS. ③The incidence of ag- itation and the VRS score were decreased in group P, and there were statistically significant difference between two groups （P〈0.05）. Conclusion： Preemptive analgesia with parecoxib sodium can decrease the changes in hemodynamics, incidence of agitation and the VRS score from intravenous anesthesia with propofol-fentanyl in patients who were undergoing gynecological laparoscopic surgery.