【作者】 郝明珠；

【导师】 柳顺锁；

【作者基本信息】 河北医科大学 ， 麻醉学， 2010， 硕士

【摘要】 目的:探讨术前静脉注射帕瑞昔布超前镇痛对丙泊酚瑞芬太尼全凭静脉麻醉腹腔镜胆囊切除术后疼痛的影响方法:采用前瞻、双盲、随机、对照研究的方法。拟在丙泊酚、瑞芬太尼全凭静脉麻醉下行腹腔镜胆囊切除术患者60例。年龄18~65岁,男女不限,ASAⅠ级或Ⅱ级,随机分成对照组(A组)、超前镇痛用药组(B组)、术毕用药镇痛组(C组),每组20例。A组于麻醉诱导前30min生理盐水5ml静脉注射,在术毕缝皮时给予生理盐水5ml静脉注射。B组于麻醉诱导前30min静脉注射帕瑞昔布40mg (5ml生理盐水溶解),术毕缝皮时给予生理盐水5ml静脉注射。C组麻醉诱导前30min给予生理盐水5ml静脉注射,在术毕缝皮时给予帕瑞昔布40mg(5ml生理盐水溶解)静脉注射。观察三组患者手术结束清醒后24h疼痛评分,当术后患者静息状态疼痛程度超过4分时(总分10分),给予肌肉注射芬太尼50μg/次。记录术后24h阿片类镇痛药使用和副作用的发生情况。分别测定三组患者麻醉前、手术结束时、术后24h血浆P物质(substance P)和白细胞介素6(interleukin 6,IL-6)浓度。结果:1一般资料比较三组患者性别、年龄、体重、身高、体重指数(body mass index,BMI)以及手术时间比较,差异无统计学意义,P >0.05,见附表Table 1。2三组患者术后24h疼痛评分不同处理组间差异无统计学意义, P >0.05,见附图Fig.1。3三组患者术后阿片类药物需要量比较,差异有统计学意义,超前镇痛组小于空白对照组、术毕镇痛组,P <0.05,见附表Table2。4血浆IL-6三组间不同时间点间,不同处理组间差异有统计学意义,P <0.05,见附图Fig.2、附图Fig.3、附表Table35.血浆P物质不同处理组间比较差异无统计学意义,P >0.05,见附图Fig.4、附表Table4。结论:1术前静脉注射帕瑞昔布超前镇痛在维持术后疼痛强度一致的条件下,能够显著减少术后阿片类药物的使用。2术前静脉注射帕瑞昔布超前镇痛显著降低患者体内IL-6的释放。3尚不能说明帕瑞昔布超前镇痛明显抑制了手术后血浆P物质的释放,有待进一步进行研究。更多还原

【Abstract】 Object: To determine The effect of pre-operative parecoxib injected as preemptive analgesia on postoperative pain after laparoscopic cholecystectomy of total intravenous anesthesia.Methods: A prospective,double-blind,randomized,placebo-controlled study was conducted on 60 patients who underwent elective laparoscopic cholecystectomy under general anesthesia at the Third Hospital of Hebei Medical University, Shijiazhuang, from September 2009 to December 2009. Patients were randomly divided into three groups(n=20), control group (groupA), preemptive analgesia treatment group (group B), normal analgesia treatment group (group C). Patients were randomized to receive eigher normal saline infusion 30 min before induction of anesthesia and 40 mg parecoxib infusion at the time of suturing skin(group C),40 mg parecoxib infusion 30 min before induction of anesthesia and normal saline infusion at the time of suturing skin(group B), or normal saline infusion 30 min before induction of anesthesia and normal saline infusion at the time of suturing skin as a placebo(group A).The degree of the postoperative pain was assessed in the first 24 h after surgery using visual analog scales(VAS). Fentanil 50μg was injected when the degree of pain exceed 4scale in VAS. The consumption of analgesics ,and the condition of side effect was recorded. Venous blood samples were collected before experiment and at suturing skin, 24h after surgery. Concentrations of substance P in plasma and interleukin 6 in plasma were measuredwith Elisa method.Results:1. No significant differences were found in age,body mass index and operation duration among the three groups, P >0.05.2. The pain scores at each time point statistically insignificant differed among the three groups, P >0.05 .3. Analgesic consumption was significant difference among the three groups. Compared with group A and group C,Analgesic consumption in group B was obviously reduced(P <0.05).4. The concentrations of interleukin 6 in three groups were similar and statistically insignificant before surgery(P﹥0.05).The concentrations of interleukin 6 in three groups were similar and statistically insignificant before surgery(P﹥0.05).Plasma interleukin 6 concentrations in three groups during and after operation were significantly higher than those before surgery. there was significant difference of plasma interleukin 6 in three groups during operation and 24h after surgery.5. The concentrations of substance P in three groups were similar and statistically insignificant before surgery(P﹥0.05).Plasma substance P concentrations in three groups during and after operation were significantly higher than those before surgery. there was insignificant difference of plasma substance P in three groups during operation and 24h after surgery.Conclusion:1. Pre-operative infusion 40 mg parecoxib could significantly reduce the postoperative opioid consumption .2. Pre-operative infusion 40 mg parecoxib could significantly inhibit the production of interleukin 6 in plasma.3. Pre-operative infusion 40 mg parecoxib could not be proved to inhibite the production of substance P in plasma.更多还原