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目的:观察帕瑞昔布钠术前镇痛对直肠癌根治术患者术后芬太尼用量的影响。方法:选择2013年1月至2014年6月我院肛肠科择期在全麻下行开腹直肠癌根治术的患者90例,ASAⅠ~Ⅱ级,年龄50~75岁,采用随机表法分为3组,每组30例。A组于手术切皮前30 min静脉注射帕瑞昔布钠40 mg(溶于4 m L 0.9%氯化钠溶液),B组手术结束前30 min静脉注射帕瑞昔布钠40 mg,C组手术切皮前30 min注射生理盐水4 m L。术后均采用静脉芬太尼PCIA。观察并记录术后2,6,12,24,48 h VAS和Ramsay评分,记录术后48 h芬太尼总用量及术后恶心、呕吐、头晕和呼吸抑制情况。结果:与C组比较,术后2,6,12 h,A组和B组VAS评分和Ramsay评分明显降低(P<0.05),与A组比较,B组和C组术后镇痛芬太尼总用量明显增加(P<0.05),术后恶心、呕吐、头晕发生率明显升高(P<0.05),3组无一例呼吸抑制。结论:1帕瑞昔布钠40 mg静脉注射对直肠癌根治术患者的术后疼痛有较好的镇痛效果,能有效减少直肠癌根治术患者术后PCIA芬太尼用量。2相对于手术结束前给药,手术开始前即给予帕瑞昔布钠更能充分发挥其临床镇痛效果,降低不良反应发生率。
Objective: To observe the effect of preoperative analgesia with parecoxib on the amount of fentanyl in patients undergoing radical resection of rectal cancer. Methods: From January 2013 to June 2014, 90 patients with ASA Ⅰ ~ Ⅱ grade ASAⅠ ~ Ⅱ, aged 50 ~ 75 years undergoing radical anastomosis under general anesthesia, were randomly divided into three groups Group, 30 cases in each group. Group A received intravenous injection of parecoxib sodium 40 mg (dissolved in 4 mL of 0.9% sodium chloride solution) 30 min prior to surgical incision, group B received parecoxib 40 mg, C The rats were injected with normal saline (4 m L) 30 min before operation. Intravenous fentanyl PCIA was used. The VAS and Ramsay scores at 2, 6, 12, 24 and 48 h after operation were observed and recorded. The total amount of fentanyl and postoperative nausea, vomiting, dizziness and respiratory depression at 48 h were recorded. Results: Compared with group C, the VAS score and Ramsay score of group A and group B were significantly decreased at 2, 6, 12 h after operation (P <0.05). Compared with group A, (P <0.05). The incidence of postoperative nausea, vomiting and dizziness were significantly increased (P <0.05). No respiratory depression was found in the three groups. Conclusion: (1) Intravenous injection of 40 mg parecoxib sodium has a good analgesic effect on postoperative pain in patients undergoing radical resection of rectal cancer, which can effectively reduce the amount of PCIA used in patients undergoing rectal cancer surgery. 2 relative to the end of surgery prior to the administration of parecoxib given before the start of surgery to give full play to its clinical analgesic effect and reduce the incidence of adverse reactions.