| 摘要: |
| 目的观察地佐辛联合帕瑞昔布的患者自控静脉镇痛（PCIA）在腹股沟疝无张力修补术在围术期多模式镇痛的临床效果，以及对血清中P物质和五羟色胺（5-HT）水平的影响。方法将90例择期行腹股沟疝无张力修补术的成年男性患者按随机数字表法分为地佐辛组（D组）、地佐辛联合帕瑞昔布组（DP组）和帕瑞昔布组（P组），每组30例。3组患者均在腹股沟区局部神经阻滞加切口局部浸润麻醉下手术，术后使用PICA进行疼痛管理，术后PCIA镇痛药物配方为：D组地佐辛0.8mg/kg+0.9%氯化钠注射液100ml，DP组地佐辛0.4mg/kg+帕瑞昔布0.6mg/kg+0.9%氯化钠注射液100ml，P组为帕瑞昔布1.2mg/kg+0.9%氯化钠注射液100ml。观察并记录患者术后0、6、12、24、48hVAS疼痛评分、Ramsay镇静评分以及BCS舒适度分级。检测术前及术后12、24及48h外周血清中P物质及5-HT水平。观察并记录患者术后48h不良反应发生情况。结果在术后6、12、24hD组及DP组VAS评分低于P组、BCS分级高于P组（均P＜0.05）；在术后6、12、24hD组的Ramsay镇静评分高于DP组及P组（P＜0.05）。术后12、24、48h患者血清中P物质和5-HT水平较术前明显升高（P＜0.01）；术后12、24、48hD组及DP组的血清中P物质及5-HT水平低于P组（P＜0.05）。DP、P组与D组比较头晕和嗜睡的发生例数较少（P＜0.05）；D组、DP组与P组比较发生胃部不适的例数较少（P＜0.05）。结论地佐辛联合帕瑞昔布的PCIA是参与局部麻醉下腹股沟疝无张力修补术围术期多模式镇痛有效手段；同时可以抑制术后P物质和5-HT的升高而不良反应更少。 |
| 关键词: 地佐辛 帕瑞昔布 局部麻醉 腹股沟疝 自控静脉镇痛 |
| DOI： |
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| Analgesic effect of patient-controlled intravenous analgesia with dezocine and parecoxib in management of perioperative pain |
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CHEN Jian, ZHANG Chunjie, HUANG Leilei
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Tongde Hospital of Zhejiang Province
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| Abstract: |
| Objective To evaluate the perioperative multimodal analgesic effects of patient-controlled intravenous analgesia (PCIA) with dezocine and parecoxib in inguinal hernia repair. and its effects on serum. Methods Ninety adult male patients scheduled for inguinal hernia repair under local anesthesia were randomized into three groups (n=30 in each group) according to the analgesics given for PCIA: group D (dezocine 0.8mg/kg), group DP (dezocine 0.4 mg/kg plus parecoxib 0.6 mg/kg) and group P (parecoxib 1.2mg/kg)．Medicines were diluted with normal saline to 100m1 in the three groups. Visual analogue scale(VAS), Ramsay sedation scale (RSS) and Bruggrmann Comfort Scale (BCS) were assessed at 0, 6, 12, 24 and 48h postoperatively．Serum P substance(PS) and 5-hydroxytryptamine(5-HT) concentrations were measured before and 12, 24, 48h after operation．Side effects were recorded within 48h after operation. Results At 6, 12 and 24 h after surgery, VAS was higher
in group P than that groups DP and D (P＜0.05). RSS scores were lower in groups P and DP than that in group D (P＜0.05), and BCS scores was lower in group P than those in groups DP and D(P＜0.05)．Serum PS and 5-HT concentrations increased at 12, 24 and 48 h after operation compared to those before operation (P＜0.05)．Groups DP and D had lower serum PS and 5-HT concentrations at 12, 24 and 48 h after operation than group P(P＜0.05)．Groups P and DP had lower incidence of dizziness and drowsiness than group D (P＜0.05)．Groups DP and D had lower incidence of stomachache than group T (P＜0.05). Conclusion Dezocine combined with parecoxib is more effective in perioperative multimodal analgesia for inguinal hernia repair with less side effects, which may be associated with the inhibition of PS and 5-HT after operation． |
| Key words: Dezocin Parecoxib Local anesthesia Inguinal hernia Patient-controlled intravenous analgesia |
