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目的:观察帕瑞昔布钠不同给药方式对乳腺癌改良根治术患者术后吗啡镇痛的影响。方法:择期行乳腺癌改良根治术患者60例,年龄45～69岁,ASAⅠ～Ⅱ级,随机分为2组(n=30):帕瑞昔布钠超前镇痛组(A组)和帕瑞昔布钠常规镇痛组(B组)。静脉注射咪达唑仑、丙泊酚、舒芬太尼、维库溴铵麻醉诱导,吸入七氟烷,间断给予舒芬太尼或维库溴铵维持麻醉。A组切皮前15 min静脉注射首剂帕瑞昔布钠40 mg,手术结束前30 min静脉注射0.9%氯化钠注射液2 ml,间隔12 h后静脉注射帕瑞昔布钠40 mg;B组切皮前15 min静脉注射0.9%氯化钠注射液2 ml,手术结束前30 min静脉注射首剂帕瑞昔布钠40 mg,间隔12 h后静脉注射帕瑞昔布钠40 mg。术毕两组患者均采用吗啡患者自控镇痛,记录术后2、4、8、12、24 h的视觉模拟评分(VAS),24 h按压总次数和有效按压次数,术后24 h吗啡用量和不良反应发生情况。结果:与B组比较,A组术后各时点VAS评分差异均无统计学意义,24 h总按压次数和有效按压次数均明显减少,术后24 h吗啡用量减少(P<0.05),两组患者术后不良反应发生无明显差异(P>0.05)。结论:帕瑞昔布钠联合吗啡多模式超前镇痛对乳腺癌改良根治术患者术后镇痛,可减少吗啡用量,有利于患者恢复。
Objective: To observe the effect of different modes of administration of parecoxib on postoperative morphine analgesia in patients with modified radical mastectomy. Methods: Sixty patients (45 ~ 69 years old, grade ASA ~ Ⅱ) undergoing modified radical mastectomy were randomly divided into 2 groups (n = 30): Parecoxib sodium preemptive analgesic group (group A) Roceoxib sodium routine analgesic group (B group). Intravenous midazolam, propofol, sufentanil, vecuronium induction of anesthesia, sevoflurane inhalation, intermittent administration of sufentanil or vecuronium to maintain anesthesia. A group of 15 minutes before skin incision intravenous injection of the first dose of parecoxib sodium 40 mg, intravenous 0.9% sodium chloride injection 2 ml 30 min before the end of surgery, parenteral parecoxib sodium 40 mg after 12 h; In group B, 2 ml of 0.9% sodium chloride injection was intravenously injected 15 min before skin incision. The first dose of parecoxib 40 mg was intravenously injected 30 min before the end of surgery, and parecoxib 40 mg was intravenously injected 12 h after the interval. At the end of operation, patients in two groups were controlled analgesia with morphine. The visual analogue scale (VAS) was recorded at 2, 4, 8, 12 and 24 hours after operation. The total number of compressions and the number of effective compressions at 24 hours were recorded. And adverse reactions occurred. Results: Compared with group B, there was no significant difference in VAS scores between groups A and B at 24 h after operation. The total number of compression and effective compression at 24 h were significantly decreased, while the dosage of morphine at 24 h after operation decreased (P <0.05) There was no significant difference in postoperative adverse reactions between the two groups (P> 0.05). Conclusion: Parecoxib sodium combined with morphine multimodal lead analgesia can improve postoperative analgesia in patients with modified radical mastectomy and reduce the dosage of morphine, which is beneficial to the recovery of patients.