帕瑞昔布钠静脉注射联合罗哌卡因切口浸润在经鼻蝶入路鞍区占位切除术后镇痛的临床研究

摘要

目的 观察帕瑞昔布钠静脉注射联合罗哌卡因切口浸润在经鼻蝶入路鞍区占位切除术后的镇痛效果及安全性.方法 采用前瞻性、随机、对照、双盲的研究方法,将择期经鼻蝶入路鞍区占位切除术患者80例随机分为4组(n=20),A组采用安慰剂10mL静脉注射+安慰剂2mL切口局部浸润;P组帕瑞昔布钠40mg静脉注射+安慰剂2mL切口局部浸润;L组安慰剂10mL静脉注射+1%罗哌卡因2mL切口局部浸润;PL组帕瑞昔布钠40mg静脉注射+1%罗哌卡因2mL切口局部浸润.记录术后6h、12h、24h、36h、48h VAS评分,患者镇痛满意度,使用2%利多卡因滴鼻的补救镇痛人数;观察恶心呕吐、皮肤瘙痒、心血管不良事件、局麻药物中毒等相关不良反应.结果 A组术后24h内各时点VAS评分均高于P组、L组以及PL组,差异有统计学意义(P<0.05);PL组与P组比较术后6h VAS评分更低,差异有统计学意义(P<0.05);PL组与L组比较术后12h、24h VAS评分低,差异有统计学意义(P<0.05);PL组副作用与其余3组比较差异无统计学意义(P>0.05).结论 帕瑞昔布钠静脉注射联合罗哌卡因切口局部粘膜浸润用于神经外科经鼻蝶入路鞍区占位切除术后镇痛效果确切,安全性较好.%Objective To observe the post-operative analgesia effect and safety of intravenous injection of parecoxib sodium combined with ropivacaine incision infiltration in transsphenoidalsellar tumor resection.Methods 80 cases of patients undergoing elective transsphenoidalsellar tumor resection were randomly divided into 4 groups(n=20) with a prospective,randomized,controlled and double-blind method.Group A received 10ml placebo for intravenous injection and 2ml placebo for local incision infiltration.Group p was treated with 40mg parecoxib sodium for intravenous injection and 2ml placebo for local incision infiltration.Group L were given 10ml placebo for intravenous and 2ml 1% ropivacainefor local incision infiltration.And group PL were treated with 40mg parecoxib sodium for intravenous injection and 2ml 1% ropivacaine for local incision infiltration.After operation,the VAS score at 6th hour,12th hour,24th hour,36th hour and 48th hour,analgesia satisfaction of patients and the number of patients with 2% lidocaine nasal drops for rescue analgesia were recorded.Adverse reaction including skin itching,nausea,vomiting,adverse cardiovascular events and local anesthetics poisoning were observed.Results TheVAS score within 24 hours of group A was higher than other three groups(P<0.05).The VAS score at 6th hour after operation of group PL was lower than that of Group P(P<0.05).The VAS score at 12th hour and 24th hour after operation of group PL were lower than those of Group L(P<0.05).There were no significant difference in side effect between group PL and other three groups(P>0.05).Conclusion It has an exact analgesia effect and safety to adopt intravenous injection of parecoxib sodium combined with ropivacaine incision infiltration in transsphenoidalsellar tumor resection.