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不同NSAIDs联合PICA在妇科腹腔镜手术患者术后镇痛中的作用及其对血清相关指标的影响
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| 篇名： | 不同NSAIDs联合PICA在妇科腹腔镜手术患者术后镇痛中的作用及其对血清相关指标的影响 |
| TITLE： | Effects of Different NSAIDs Combined with PICA on Postoperative Analgesia in Patients Undergoing Gynecolo- gical Laparoscopic Surgery and Its Effect on Serum Related Factors |
| 摘要： | 目的：探讨帕瑞昔布钠、氟比洛芬酯、氯诺昔康联合自控静脉镇痛（PICA）在妇科腹腔镜手术患者术后镇痛中的作用及其对血清相关指标的影响。方法：选取2017年3月－2019年3月在海南医学院第二附属医院接受妇科腹腔镜手术的患者280例，根据随机数字表法分为对照组（C组）、帕瑞昔布钠组（P组）、氟比洛芬酯组（F组）和氯诺昔康组（L组），每组70例。4组患者均于术毕前30min分别静脉注射氯化钠注射液5mL、注射用帕瑞昔布钠40mg、氟比洛芬酯注射液50mg、注射用氯诺昔康8mg（效果欠佳时加用8mg），手术结束后给予枸椽酸舒芬太尼注射液和地佐辛注射液PICA镇痛。采用数字评分法（NRS）评估4组患者术后6、12、24、48h的疼痛、恶心情况；采用化学发光法和酶联免疫吸附法分别检测4组患者术前及术后6、12、24、48h时的血清C反应蛋白（CRP）以及白细胞介素6（IL-6）、心肌细胞P物质（SP）、前列腺素E（2PGE2）水平；记录4组患者术后24h内镇痛泵按压次数及镇痛药物用量；记录患者术后48h内的腹胀、呕吐、眩晕、皮肤瘙痒、呼吸抑制、尿潴留等不良反应（ADR）的发生情况。结果：在上述各检测时间点，P、F、L组患者的NRS评分均显著低于C组；且术后48h时，L组患者的疼痛NRS评分显著低于P组与F组（P＜0.05）。术前，4组患者的CRP、IL-6、SP、PGE2水平比较，差异均无统计学意义（P＞0.05），术后各时间点的P、F、L组患者的CRP、IL-6、SP、PGE2水平均显著低于C组；F组患者术后48h的血清SP水平及术后12、24、48h的血清PGE2水平，L组患者术后48h的血清IL-6水平，术后24、48h的血清SP水平以及术后12、24、48h的血清PGE2水平均显著低于P组；L组患者术后48h的血清SP水平以及术后12、24、48h的血清PGE2水平均显著低于F组（P＜0.05）。4组患者间腹胀、呕吐的发生率比较差异均无统计学意义（P＞0.05）。结论：帕瑞昔布钠、氟比洛芬酯、氯诺昔康联合PICA均能够有效缓解妇科腹腔镜手术患者术后疼痛，降低其血清相关指标水平，且氯诺昔康的作用可能更优。 |
| ABSTRACT： | OBJECTIVE：To investigate the effects of parecoxib sodium ，flurbiprofen axetil and lornoxicam combined with patient controlled intravenous analgesia （PICA） on postoperative analgesia in patients undergoing gynecological laparoscopic surgery and its effect on serum related factors. METHODS ：A total of 280 patients who underwent gynecologic laparoscopic surgery in the Second Affiliated Hospital of Hainan Medical University from Mar. 2017 to Mar. 2019 were randomly divided into control group （group C ），parecoxib sodium group （group P ），and flurbiprofen axetil group （group F ）and lornoxicam group （group L ）acording to random number table ，with 70 patients in each group. Four groups of patients received Sodium chloride injection 5 mL，Parecoxib sodium for injection 40 mg，Flurbiprofen axetil injection 50 mg and Lornoxicam for injection 8 mg （added 8 mg when the effect was not good ）intravenously at 30 min before the end of surgery. At the end of surgery ，they were given PICA of Sufentanil citrate injection and Dizosin injection for analgesia. The situation of pain and nausea symptom were evaluated at 6，12，24 and 48 h after surgery by using numerical rating scale （NRS）. The levels of serum CRP ，IL-6，SP and PGE 2 were detected by chemiluminescence method and ELISA. The times of pressing PICA pump and the dosage of analgesic were recorded in 4 groups within 24 h after surgery. The ADRs of patients within 48 h after surgery were recorded ，such as bloating ， dizziness，itchy skin ，respiratory depression and urinary retention. RESULTS ：At different time points ，the NRS scores of pain of group P ，F and L were significantly lower than those of group C ；and 48 h after surgery ，NRS score of pain of group L was significantly lower than those of group P and F （P＜0.05）. There was no statistical significance in the level of CRP ，IL-6，SP and PGE2 of 4 groups before surger （P＞0.05）. The CRP ，IL-6，SP and PGE 2 levels at each time point after surgery of group P ，F and L were significantly lower than those of group C ；compared with group P ，serum level of SP at 48 h after surgery as well as serum levels of PGE 2 at 12，24 and 48 h after surgery were significantly decreased in group F ，and serum level of IL- 6 at 48 h after surgery，serum levels of SP at 24 and 48 h after surgery ，serum levels of PGE 2 at 12，24，48 h after surgery were decreased significantly in group L ；compared with group F ，serum level of SP at 48 h after surgery as well as serum levels of PGE 2 at 12， 24，48 h after surgery were all decreased significantly in group L （P＜0.05）. There was no statistical significance in the incidence of anausea and vomiting among 4 groups（P＞0.05）. CONCLUSIONS ：Parecoxib sodium ，flurbiprofen axetil and lornoxicam combined with PICA can effectively relieve the pain of patients after gynecological laparoscopic surgery and reduce the levels of serum related factor ，and lornoxicam has the most obvious effect. |
| 期刊： | 2020年第31卷第14期 |
| 作者： | 黎仕焕，李繁，黄奕第，徐志新 |
| AUTHORS： | LI Shihuan ，LI F an，HUANG Yidi，XU Zhixin |
| 关键字： | 腹腔镜；妇科；自控静脉镇痛；非甾体抗炎药；帕瑞昔布钠；氟比洛芬酯；氯诺昔康；术后镇痛 |
| KEYWORDS： | Laparoscopic；Gynecology；Patient controlled intravenous analgesia ；Non-steroidal anti-inflammatory drugs ； |
| 阅读数： | 417 次 |
| 本月下载数： | 6 次 |
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