| 卢敬利,郑翔.帕瑞昔布与地佐辛超前镇痛对肝炎肝硬化患者术后镇痛及凝血系统影响评价[J].浙江中西医结合杂志,2019,29(5): |
| 帕瑞昔布与地佐辛超前镇痛对肝炎肝硬化患者术后镇痛及凝血系统影响评价 |
| Effects of postoperative pain and coagulative function on preemptive analgesia by parecoxib combined with dezocine in the patients with hepatitis cirrhosis |
| 投稿时间：2018-06-19 修订日期：2018-10-24 |
| DOI： |
| 中文关键词: 【关键词】 帕瑞昔布 地佐辛 肝炎肝硬化 超前镇痛 凝血功能 |
| 英文关键词:parecoxib dezocine preemptive analgesia hepatitis cirrhosis coagulative function |
| 基金项目: |
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| 中文摘要: |
| 【】目的：评估肝炎肝硬化患者手术中应用帕瑞昔布与地佐辛进行超前镇痛对术后镇痛质量及凝血功能的影响。方法：选择我院96例行腹部手术的肝炎肝硬化患者进行前瞻性研究,依据随机原则分为联合组(32例,麻醉诱导前10 min帕瑞昔布与地佐辛超前镇痛)、帕瑞昔布组(32例,麻醉诱导前单用帕瑞昔布超前镇痛)与对照组(32例,麻醉诱导前予以生理盐水)。三组术后均未予以镇痛处理。分别于术后即刻(T<sub>0</sub>)、术后60min(T<sub>1</sub>)、120min(T<sub>2</sub>)、4h(T<sub>3</sub>)、12h(T<sub>4</sub>)五个时间点,评估并比较三组患者疼痛视觉模拟评分(VAS评分)、外周静脉血β-内啡肽(β-EP)及Ramsay 镇静评分的差异。术前及术后4h检测并比较三组患者凝血酶原时间(PT)、激活部分凝血酶原时间(APTT)、国际标准化比值(INR)、纤维蛋白原浓度(Fib)及血小板聚集率的差异。同时记录并比较三组患者手术时间、苏醒时间、拔管时间和苏醒期躁动发生率差异；比较三组患者术后不良反应发生率。结果：同时间点对照组VAS评分及外周血β-EP水平最高,帕瑞昔布组次之,联合组最低(P<0.05),但三组Ramsay镇静评分均无差异(P>0.05)。随着术后时间延长,三组患者VAS评分、外周血β-EP水平及Ramsay镇静评分均无显著差异(P>0.05)。术前与术后PT、APTT、INR及Fib各指标在三组间均无差异(P>0.05),在同组内PT、APTT、INR及Fib各指标术前与术后也均无差别(P>0.05)。而术前三组血小板聚集率无显著差异(P>0.05),但术后联合组最低,帕瑞昔布组次之,对照组最高(P<0.05)；且三组内术后血小板聚集率均显著低于术前(P<0.05)。三组患者手术时间、苏醒时间、拔管时间均无差异(P<0.05),但对照组苏醒期躁动发生率最高,帕瑞昔布组次之,联合组最低(P<0.05)。术后三组患者术后不良反应发生率无显著差异(P>0.05)。结论：肝炎肝硬化患者术中应用帕瑞昔布与地佐辛进行超前镇痛对术后镇痛质量更佳,对凝血功能无影响,且安全性均较好。 |
| 英文摘要: |
| Objective To evaluate the clinical effects of postoperative pain and coagulative function on preemptive analgesia by parecoxib combined with dezocine in the patients with hepatitis cirrhosis. Methods A total of 96 patients with hepatitis cirrhosis suffered with abdominal operation were chosen to prospective research and divided into three groups randomly, which were combination group (32 cases, receiving parecoxib combined with dezocine at 10min before anesthesia), parecoxib group (32 cases, receiving parecoxib at 10min before anesthesia) and control group (32 cases, receiving normal saline at 10min before anesthesia). All patients were received postoperative patient controlled analgesia. The indexes of visual analog score (VAS), serum β-endorphin (β-EP) and Ramsay score were recorded and compared among three groups at five time-points, such as immediate time (T<sub>0</sub>), 60 min (T<sub>1</sub>), 120 min (T<sub>2</sub>), 4h (T<sub>3</sub>) and 12h (T<sub>4</sub>). The indexes of PT, APTT, INR, Fib and the platelet aggregation rate were recorded and compared among three groups at pre- and post-operation. The indexes of operation time, recovery time, extubation time, and agitation occurrence were compared among three groups. The occurrences of adverse reactions were compared among three groups. Results The indexes of VAS and serum β-EP levels of control group were highest at the same time-point, and the parecoxib group was the second highest and the control group was lowest (P<0.05). But the Ramsay scores of three groups were no different (P>0.05). The VAS, serum β-EP and Ramsay scores of three groups were no different with the post-operation time went by (P>0.05). The indexes of PT, APTT, INR and Fib were no different among three groups at pre- and post-operation (all P>0.05), and the indexes of PT, APTT, INR and Fib were also no different between pre- and post-operation in each group (all P>0.05). The platelet aggregation rate were no different among three groups at pre-operation (all P>0.05), but the platelet aggregation rate of combination group was lowest at post-operation, the parecoxib group was the second lowest and the control group was highest (P<0.05). The platelet aggregation rate at pre-operation was lower than at post-operation in each group (all P<0.05). The indexes of operation time, recovery time and extubation time were no different among three groups (P<0.05). But the agitation occurrence of control group were highest, and the parecoxib group was the second highest and the control group was lowest (P<0.05). The occurrences of adverse reactions were no different among three groups (P>0.05). Conclusion The clinical effect of postoperative pain on preemptive analgesia by parecoxib combined with dezocine in the patients with hepatitis cirrhosis is perfect. The coagulative function and the safety are also good. |
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