摘要
目的观察术前应用帕瑞昔布钠对肾癌根治术患者镇痛效果及肾功能安全性的影响。方法择期行全麻下肾癌根治术患者60例,随机均分为两组。观察组于切皮前20 min静注帕瑞昔布钠40 mg,对照组静注生理盐水5 ml。术毕使用芬太尼自控镇痛泵。记录患者术后芬太尼的用量、自控镇痛次数、多时点动静态视觉模拟(VAS)评分、疼痛缓解程度评分(PR评分)和整体满意度评分(PGESM评分)及不良反应发生情况。测定患者术前、术后第1天、第3天24 h尿量、血肌酐(Cr)、尿素氮(Bun)、血β_2-微球蛋白(β_2-M)和视黄醇结合蛋白(RPB)。结果术后2、6、12 h VAS评分观察组低于对照组,PR及PGESM评分观察组优于对照组(P<0.05或P<0.01)。术后12、24 h芬太尼用量观察组较对照组分别减少26.9%和21.4%(P<0.01),而不良反应发生率两组差异无统计学意义。两组患者手术前后肾功能指标均未见明显异常改变。结论术前应用帕瑞昔布钠配合术后芬太尼自控镇痛可减少芬太尼用量,未发现该药对围术期患者的肾功能产生影响。
Objective To observe the preemptive analgesic efficacy of parecoxib on postsurgical pain management and to evaluate the effect of single dose of parecoxib 40 mg on renal function following nephrectomy. Methods In this study, 60 patients undergoing nephrectomy under general anesthesia were randomly allocated to two groups： Parecoxib group received intravenous parecoxib 40 mg 20 minutes before incision, while control group received equivalent volume of 0. 9% NaCl as placebo. All patients accepted patient-controlled intravenous analgesic （PCIA） pump with fentanyl immediately after extubation. The intensity of pain was measured by static and dynamic visual analogue scale（VAS） at 2,6,12 and 24 hours postoperatively. The fentanyl consumption, the number of delivered doses, the patient＇s pain relief（PR） and the patients global evaluation of study medication（PGESM） at 12 and 24 hours after operation, also the incidence of opioid-type side effects were recorded and compared between the two groups. Renal safety evaluation included 24 h urinary volume and some results of clinical lab tests including Bun, Cr, β2-M and RPB, which were recorded preoperatively, the first and the third day after operation. Results The static VAS scores in the parecoxib group were significantly lower than that in the control group within the first 12 hours postoperatively （P〈0. 05）. The PR and PGESM demonstrated a greater level of satisfaction among patients taking parecoxib than those taking placebo （P 〈0. 05 or P 〈0.01）. The fentanyl Consumption at 12 and 24 h after operation was significantly less than that in control group and was reduced by 26.9% and 21.4% respectively. However, a reduction in opioid-type side effects was not demonstrated in the parecoxib group. There were no serious renal dysfunctional events in both groups. Conclusion This study shows that the preincisional administration of parecoxib with fentanyl PCIA after nephrectomy resulted in significantly improved postoperative analgesic management as defined by reduction in opioid requirement and renal safety.
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2012年第3期242-244,共3页
Journal of Clinical Anesthesiology
