帕瑞昔布钠对瑞芬太尼麻醉下肢骨折患者手术后急性痛的影响

谢言虎; 柴小青; 崔中露; 高燕春; 许敏

帕瑞昔布钠对瑞芬太尼麻醉下肢骨折患者手术后急性痛的影响

Study on parecoxib sodium alleviating postoperative acute pain in patients with lower limb fracture undergoing remifentanil anesthesia

摘要

摘要: 目的:通过观察帕瑞昔布钠对下肢骨折手术患者围手术期血浆前列腺素E₂(PGE₂)、β-内啡肽(β-EP)水平的影响,探讨帕瑞昔布钠减轻瑞芬太尼麻醉术后急性痛的作用机制。方法:择期下肢骨折行切开复位内固定术患者60例,随机分为3组,每组20例。A组术前30 min静脉注射(静注)0.9%氯化钠注射液(NS)10 ml;B组术前静注帕瑞昔布钠40 mg(NS稀释至10 ml);C组术前静注帕瑞昔布钠40 mg(NS稀释至10 ml),术后每12 h静注帕瑞昔布钠40 mg,至术后48 h结束。术毕前30 min开始镇痛,配方为芬太尼15 μg/kg 加入NS 100 ml,镇痛模式为负荷剂量5 ml加持续剂量2 ml/h,补救镇痛给药每次0.5 ml,锁定时间为10 min。记录3组患者性别、年龄、体质量、手术时间和瑞芬太尼用量;分别于麻醉诱导前(T₁)、术毕1 h(T₂)、术后24 h(T₃)、术后48 h(T₄)采血,采用放射免疫分析法测定血浆β-EP、PGE₂;记录术后1、12、24、48 h 视觉模拟评分及术后48 h内自控镇痛泵按压次数,是否追加使用其它镇痛药和有无严重呼吸循环抑制。结果:3组患者的性别、年龄、体质量、手术时间和麻醉药用量差异均无统计学意义(P>0.05)。与A组比较,B、C组术后视觉模拟评分明显降低,其中C组自控镇痛泵所需按压次数最少、镇痛效果最好(P<0.05)。B、C组血浆PGE₂ T₂、T₃、T₄时点均低于A组(P<0.05～P<0.01)。C组T₃和T₄时点β-EP水平均较A组和B组升高(P<0.05～P<0.01)。结论:帕瑞昔布钠能增强阿片类药物镇痛效果,显著减轻瑞芬太尼麻醉下肢骨折手术后急性痛。其主要机制可能与抑制PGE₂生成、增加内源性β-EP释放有关。

Abstract: Objective: To observe the effect of parecoxib sodium on the level of plasma prostaglandin E₂(PGE₂) and β-endorphine(β-EP),and to explore the mechanism related to parecoxib sodium alleviating postoperative acute pain in patients with lower limb fracture undergoing remifentanil anesthesia.Methods: Sixty inpatients undergoing lower limbs fracture were randomly assigned into 3 groups.The patients in group A received a preoperative dose of normal saline 10 ml by intravenous administration.Group B received a preoperative dose of parecoxib sodium 40 mg(saline 10 ml) by intravenous administration before the operation.Group C received parecoxib sodium 40 mg before the operation,and received parecoxib sodium 40 mg every 12 h till 48 h after operation.Patient controlled intravenous analgesia was started 30 min before the end of operation,with the model(load volume 5 ml,continuous infusion at 1.5 ml/h,and bolus 0.5 ml at locked time 10 min).Analgesia mixture was consisted of fentanyl 15 μg/kg(total volume 100 ml).Visual analogue scale was recorded at 1,12,24,48 h after the operation.Valid/invalid presses,the need for additional analgesia drug within 48 h after the operation were recorded.The concentration of PGE₂ and β-EP were determined at before anesthesia induction(T₁),1 hour after the operation(T₂),24 hours after the operation(T₃),48 hours after the operation(T₄).Results: The patients among three groups were not significantly different in demographics and doses of narcotic(P>0.05).Compared with group A,Visual analogue scale scores in group B and group C significantly decreased.Presses in Patient controlled intravenous analgesia in group C were least in three groups(P<0.05).Plasma PGE₂ in group B and C at T₂,T₃,T₄ significantly decreased than group A(P<0.05 to P<0.01).Plasma β-EP in group C at T₃,T₄ were higher than that in group A and B(P<0.05 to P<0.01).Conclusions: Parecoxib sodium could heighten the effect of opioids,and significantly relieve the postoperative acute pain in patients with lower limb fracture undergoing remifentanil anesthesia.The underlying mechanism may be related to release of endogenous β-EP and inhibition of PGE₂ release.

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