摘要目的 评价颅内肿瘤切除术病人帕瑞昔布钠超前镇痛的效果.方法 择期行幕上颅内肿瘤切除术病人60例,性别不限,年龄18～60岁,体重指数<30 kg/m~2,ASA Ⅰ或Ⅱ级,随机分为2组:生理盐水组(n=30)和帕瑞昔布钠组(n=30).麻醉诱导前生理盐水组和帕瑞昔布钠组分别经2 min 静脉注射生理盐水2ml或帕瑞昔布钠加mg.术后VAS评分≥3分时行病人自控静脉镇痛(PCLA),VAS评分<3分为镇痛有效,PCIA药物为芬太尼,若PCIA仍不能满足病人术后镇痛的需求,则静脉注射芬太尼或曲马多.记录术后24 h内PCIA按压次数、有效按压次数、芬太尼用量和补救用药使用情况;术后24 h时评价恶心呕吐程度和病人对镇痛的满意度.于帕瑞昔布钠给药前和给药后2 h时测定激活凝血时间(ACT)、凝血速率(CR)和血小板功能(PF).结果 与生理盐水组比较,帕瑞昔布钠组PCIA按压次数、有效按压次数、芬太尼用量、补救用药使用率和恶心呕吐程度降低,病人对镇痛满意度升高(P<0.05),ACT、CR和PF差异无统计学意义(P>0.05).帕瑞昔布钠组给药前后ACT、CR和PF比较差异无统计学意义(P>0.05).结论 对于颅脑手术病人,麻醉诱导前给予帕瑞昔布钠可改善芬太尼PCIA的效果,产生超前镇痛作用.

abstractsObjective To investigate the efficacy of preemptive analgesia with parecoxib, a novel intravenous cyclooxygenase type-2 inhibitor, far acute postoperative pain management after intracranial tumor resection.Methods Sixty ASA I or II patients of both sexes aged 18-60 yr with body mass index < 30 kg/m~2 were randomized into 2 groups ( n = 30 each) : control group (group C) and parecoxib group (group P) . In group P, parecoxib 40 mg in 2 ml of normal saline ( NS) was injected iv over 2 min before induction of anesthesia. In group C NS 2 ml was injected instead of parecoxib. Patient controlled intravenous analgesia (PCIA) with fentanyl (bolus dose 0.05 μg/kg, lockout interval 15 min, background infusion 0.2μg·kg~ (-1)·h~(-1), 24 h maximum dose 9.6μg /kg) was used after operation. The number of successfully delivered doses and the number of attempt were calculated. If PCIA did not provide satisfactory analgesia (VAS < 3) , iv bolus of fentanyl 1μg /kg or tramadol 12 mg/kg was given as rescue medication. VAS (0 = no pain, 10 = worst pain) was used to measure pain intensity and recorded at 2, 6, 12 and 24 h after operation. Patient's satisfaction, nausea and vomiting were recorded, and activated coagulation time (ACT), coagulation rate (CR) and platelet function (PF) were measured before and 2 h after parecoxib administration. Results The consumption of fentanyl, the number of successfully delivered doses and the number of attempt, the number of rescue medication administration and degree of nausea and vomiting were significantly lower while the level of patient's satisfaction was higher in group P than in group C. There was no difference in ACT, CR and PF between the two groups. Conclusion Parecoxib given before induction of anesthesia can improve the efficacy of PCIA with fentnayl and decrease side effects.