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目的:比较帕瑞昔布、罗哌卡因单独或联合应用对腹腔镜下妇科手术的术后镇痛效果。方法:80例女性患者拟在腹腔镜下行妇科手术,患者随机分成A、B、C、D组。A组为帕瑞昔布40mg,B组局部浸润0.5%罗哌卡因20ml,C组帕瑞昔布40mg及局部浸润0.5%罗哌卡因20ml,D组采用生理盐水2ml肌肉注射作为对照。观察血压、心率、脉搏血氧饱和度,术后1、3、6、12、24h各时间点的疼痛情况,术后疼痛观察采用视觉模拟评分法(VAS,0～10)。记录需要补充哌替啶的患者人数,用方差分析比较各组间的VAS评分。结果:术后1hA、B、C组VAS评分均低于D组(P<0.05),其中C组低于A、B组(P<0.05);术后3、6hA、B、C组之间VAS评分差异无统计学意义,均低于D组(P<0.05);术后12h和24h4组的差异无统计学意义(P>0.05)。4组患者术后24h内需要补充镇痛药物哌替啶的人数是A组4人(20%),B组3人(15%),C组3人(15%),D组8人(40%),A、B、C组需要补充镇痛药的患者比D组少,(P<0.05)。结论:帕瑞昔布、罗哌卡因单独或联合应用对腹腔镜下妇科手术的术后镇痛有良好效果,其中联合应用的早期镇痛效果最好。
Objective: To compare the analgesic effect of parecoxib and ropivacaine alone or in combination on laparoscopic gynecological surgery. Methods: Eighty female patients were scheduled for laparoscopic gynecological surgery. The patients were randomly divided into A, B, C and D groups. A group of parecoxib 40mg, B group infiltration 0.5% ropivacaine 20ml, C group parecoxib 40mg and local infiltration 0.5% ropivacaine 20ml, D group using saline 2ml intramuscular injection as a control. The blood pressure, heart rate, pulse oximetry, postoperative pain at 1, 3, 6, 12 and 24 hours were observed. Visual acuity score (VAS, 0-10) was used to observe postoperative pain. The number of patients requiring pethidine supplementation was recorded and VAS scores were compared between groups by analysis of variance. Results: The VAS score of 1h, B, C group was lower than that of D group (P <0.05), and C group was lower than A and B group (P <0.05) There was no significant difference in VAS score between the two groups (all P <0.05). There was no significant difference between the two groups at 12h and 24h after operation (P> 0.05). Four patients in group A (n = 4) (20%), three in group B (15%), three in group C (15%) and eight in group D (n = 40%). Patients in groups A, B and C who needed analgesics were less than those in group D (P <0.05). Conclusions: Parecoxib and ropivacaine, alone or in combination, have good effect on postoperative analgesia of laparoscopic gynecological surgery. The combination of parecoxib and ropivacaine has the best early analgesic effect.