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目的观察帕瑞昔布钠超前镇痛于不同时间点应用对胃癌根治术老年患者术后镇痛的影响,并探讨其安全性。方法回顾性分析本院收治的78例需行胃癌根治术老年患者临床资料,随机分为2组,观察组于麻醉诱导前静脉注射帕瑞昔布钠40 mg,对照组于手术结束时刻静脉注射帕瑞昔布钠40 mg。2组均于手术结束时衔接静脉自控镇痛泵:舒芬太尼0.8μg/(kg·d)+昂丹司琼16 mg+地佐辛10 mg+生理盐水配置成100 ml,设置速度为2 ml/h,自控15 min,2 ml/次。比较2组手术结束时刻、术后6 h、术后24 h、术后48 h平均动脉压(MAP)及心率(HR)水平,记录2组术后不同时刻视觉模拟评分(VAS)水平及术后24 h静脉镇痛泵按压次数及舒芬太尼使用总量;统计2组不良反应发生率。结果观察组于手术结束时刻、术后24 h平均动脉压及心率水平均低于对照组(均P<0.05),血流动力学更为稳定;观察组术后6h、术后12 h、术后24 h、术后48 h VAS评分均低于对照组(均P<0.05);观察组24 h自控镇痛泵按压次数及舒芬太尼使用总量均低于对照组(均P<0.05);2组不良反应发生率比较差异无统计学意义(P>0.05)。结论帕瑞昔布钠超前镇痛麻醉前应用降低胃癌根治术老年患者术后疼痛效果显著,血流动力学稳定,且不增加不良反应,应用安全。
Objective To observe the effect of parecoxib sodium advanced analgesia on postoperative analgesia in elderly patients with radical gastrectomy at different time points and to investigate its safety. Methods The clinical data of 78 elderly patients undergoing radical gastrectomy for gastric cancer were retrospectively analyzed. The patients in the observation group were given parecoxib sodium 40 mg intravenously before anesthesia induction and the control group received intravenous injection at the end of surgery Parecoxib sodium 40 mg. Both groups were given intravenous analgesia pump at the end of surgery: sufentanil 0.8μg / (kg · d) + ondansetron 16 mg + dezocine 10 mg + saline solution to 100 ml, the setting speed of 2 ml / h, controlled 15 min, 2 ml / time. The mean arterial pressure (MAP) and heart rate (HR) at 6 h after operation, 6 h after operation, 24 h after operation and 48 h after operation were compared between the two groups. The visual analogue scale (VAS) 24 h after intravenous analgesia pump press and sufentanil total use; statistics, two groups of adverse reactions. Results At the end of operation, the average arterial pressure and heart rate at 24 hours after operation were lower than those in control group (all P <0.05), and the hemodynamics were more stable in observation group. After 6 hours and 12 hours after operation, VAS scores at 24 h and 48 h after operation were significantly lower than those in the control group (all P <0.05). The number of pressures and sufentanil used in the 24 h postoperatively in the observation group were lower than those in the control group ). There was no significant difference in the incidence of adverse reactions between the two groups (P> 0.05). Conclusion Preoperative analgesia with parecoxib used before anesthesia to reduce the effect of postoperative pain in elderly patients with radical gastrectomy, hemodynamic stability, and does not increase the adverse reactions, the application of safety.