选择性COX-2抑制剂在开腹肝脏术后镇痛的应用
| 作者: |
1陈美婷,
1金保,
2裴丽坚,
2朱波,
1迟天毅,
1徐海峰,
1郑永昌,
1徐意瑶,
1赵海涛,
1杜顺达,
1卢欣,
1毛一雷,
1桑新亭,
2黄宇光
1 中国医学科学院北京协和医学院北京协和医院肝脏外科，北京 100730 2 中国医学科学院北京协和医学院北京协和医院麻醉科，北京 100730 |
| 通讯: |
杜顺达
Email: DuShD@pumch.cn |
| DOI: | 10.3978/.2018.01.014 |
摘要
目的：探讨选择性环氧合酶2（COX-2）抑制剂帕瑞昔布钠在开腹肝脏术后镇痛的应用效果。
方法：选取2014年9月—2016年12月北京协和医院肝脏外科56例行开腹肝脏海绵状血管瘤切除术患者，随机分为对照组与观察组，每组28例，对照组行静脉自控镇痛（PCA），观察组行静脉PCA+帕瑞昔布钠镇痛。比较两组围手术期相关指标、术后镇痛效果、恢复情况及不良反应。
结果：两组患者术前资料与术中指标均无统计学差异（均P>0.05）；术后两组血氨水平、门静脉流速较术前均无明显变化（均P>0.05）；红细胞沉降率、超敏C反应蛋白水平均较术前明显增加（均P<0.05），但两组间均无统计学差异（均P>0.05）。观察组术后第1、2天静息与活动后VAS评分、术后第3天静息VAS评分以及使用镇痛药物剂量均明显低于对照组（均P<0.05）；观察组整体需要疼痛补救的患者例数明显少于对照组（5例vs. 17例，P=0.001），观察组术后呕吐发生率低于对照组（17.8% vs. 46.4%，P<0.05），而两组术后恶心发生率、恢复情况及住院费用无统计学差异（均P>0.05）。
结论：开腹肝脏手术后镇痛中联合应用帕瑞昔布钠是安全的，可有效改善疼痛，降低阿片类药物用量，减少术后不良反应，且并不增加住院费用。
关键词：
肝切除术；疼痛，手术后；环氧化酶2抑制剂；镇痛
方法：选取2014年9月—2016年12月北京协和医院肝脏外科56例行开腹肝脏海绵状血管瘤切除术患者，随机分为对照组与观察组，每组28例，对照组行静脉自控镇痛（PCA），观察组行静脉PCA+帕瑞昔布钠镇痛。比较两组围手术期相关指标、术后镇痛效果、恢复情况及不良反应。
结果：两组患者术前资料与术中指标均无统计学差异（均P>0.05）；术后两组血氨水平、门静脉流速较术前均无明显变化（均P>0.05）；红细胞沉降率、超敏C反应蛋白水平均较术前明显增加（均P<0.05），但两组间均无统计学差异（均P>0.05）。观察组术后第1、2天静息与活动后VAS评分、术后第3天静息VAS评分以及使用镇痛药物剂量均明显低于对照组（均P<0.05）；观察组整体需要疼痛补救的患者例数明显少于对照组（5例vs. 17例，P=0.001），观察组术后呕吐发生率低于对照组（17.8% vs. 46.4%，P<0.05），而两组术后恶心发生率、恢复情况及住院费用无统计学差异（均P>0.05）。
结论：开腹肝脏手术后镇痛中联合应用帕瑞昔布钠是安全的，可有效改善疼痛，降低阿片类药物用量，减少术后不良反应，且并不增加住院费用。
Application of selective cyclooxygenase-2 inhibitor in postoperative analgesia of open liver surgery
CorrespondingAuthor:DU Shunda Email: DuShD@pumch.cn
Abstract
Objective: To investigate the efficacy of using selective cyclooxygenase-2 (COX-2) inhibitor parecoxib for postoperative analgesia of open liver surgery.
Methods: Fifty-six patients undergoing open liver resection for cavernous hemangioma of the liver in Peking Union Medical College Hospital from September 2014 to December 2016 were enrolled and were randomly designated to control group and observation group, with 28 cases in each group. Patients in control group underwent patient-controlled analgesia (PCA), and those in observation group received PCA plus parecoxib treatment. The relevant perioperative variables, postoperative analgesic effects, recovery variables and adverse effects were compared between the two groups of patients.
Results: There were no significant differences in preoperative data and intraoperative variables between the two groups of patients (all P>0.05). After operation, the blood ammonia levels and portal vein velocities showed no significant changes (both P>0.05) while the erythrocyte sedimentation rates and levels of high-sensitivity C-reactive protein were significantly increased in both groups after operation compared with their preoperative values (both P<0.05), but all these parameters showed no significance between the two groups (all P>0.05). The postoperative day (POD) 1 and 2 resting and exertion pain VAS scores, POD 3 resting pain VAS score and dose of analgesics used were all significantly reduced in observation group compared with control group (all P<0.05); the number of cases requiring additional pain relief was significantly decreased in observation group compared with control group (5 cases vs. 17 cases, P=0.001), and the incidence of postoperative vomiting was significantly decreased in observation group compared with control group (17.8% vs. 46.4%, P<0.05). No significant differences were noted in incidence of postoperative nausea, recovery variables and hospitalization costs between the two groups (all P>0.05).
Conclusion: For postoperative analgesia of open liver surgery, combined use of parecoxib is safe and can effectively relieve pain and reduce the dose of opioids and the adverse effects, and meanwhile will not increase the hospitalization costs.
Keywords：
Hepatectomy; Pain
Postoperative; Cyclooxygenase 2 Inhibitors; Parecoxib; Analgesia
Methods: Fifty-six patients undergoing open liver resection for cavernous hemangioma of the liver in Peking Union Medical College Hospital from September 2014 to December 2016 were enrolled and were randomly designated to control group and observation group, with 28 cases in each group. Patients in control group underwent patient-controlled analgesia (PCA), and those in observation group received PCA plus parecoxib treatment. The relevant perioperative variables, postoperative analgesic effects, recovery variables and adverse effects were compared between the two groups of patients.
Results: There were no significant differences in preoperative data and intraoperative variables between the two groups of patients (all P>0.05). After operation, the blood ammonia levels and portal vein velocities showed no significant changes (both P>0.05) while the erythrocyte sedimentation rates and levels of high-sensitivity C-reactive protein were significantly increased in both groups after operation compared with their preoperative values (both P<0.05), but all these parameters showed no significance between the two groups (all P>0.05). The postoperative day (POD) 1 and 2 resting and exertion pain VAS scores, POD 3 resting pain VAS score and dose of analgesics used were all significantly reduced in observation group compared with control group (all P<0.05); the number of cases requiring additional pain relief was significantly decreased in observation group compared with control group (5 cases vs. 17 cases, P=0.001), and the incidence of postoperative vomiting was significantly decreased in observation group compared with control group (17.8% vs. 46.4%, P<0.05). No significant differences were noted in incidence of postoperative nausea, recovery variables and hospitalization costs between the two groups (all P>0.05).
Conclusion: For postoperative analgesia of open liver surgery, combined use of parecoxib is safe and can effectively relieve pain and reduce the dose of opioids and the adverse effects, and meanwhile will not increase the hospitalization costs.