帕瑞昔布钠预防性镇痛联合超声引导下腹横肌平面阻滞用于妇科全子宫切除术后镇痛的效果

doi:10.3969/j.issn.1006-6233.2022.04.023

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摘要 目的:探讨超声引导下腹横肌平面阻滞(TAPB)联合帕瑞昔布钠(PCX)用于妇科全子宫切除术术后镇痛的效果及对疼痛介质的影响。方法: 选取我院2018年07月至2021年11月择期行经腹全子宫切除术的80例患者,以简单随机分组法分为两组各40例,对照组给予TAPB复合全麻,研究组在对照组基础上给予PCX。观察两组麻醉情况,检测患者入院时(术前)、术后6h、术后12h、术后24h的前列腺素E2(PGE2)、P物质(SP)、β-内啡肽(β-EP)、五羟色胺(5-HT)等疼痛介质水平,使用舒适评分(BCS)、视觉模拟评分法(VAS)评估患者出室、术后6h、术后12h、术后24h的疼痛。结果: 研究组瑞芬太尼用量明显少于对照组,自主呼吸恢复、苏醒、首次肛门排气、下床活动等时间明显短于对照组(P<0.05);PGE2、SP、β-EP、5-HT水平术后逐渐升高,术后6h达峰后逐渐降低,且研究组PGE2、SP、5-HT水平术后6h、术后12h、术后24h明显低于对照组,研究组β-EP水平术后6h、术后12h、术后24h明显高于对照组(P<0.05);VSA评分出室后逐渐升高,且研究组术后6h、术后12h、术后24h明显低于对照组(P<0.05);BCS评分术后逐渐降低,且研究组术后6h、术后12h、术后24h明显高于对照组(P<0.05);两组不良反应发生率无统计学差异(P>0.05)。结论: PCX与TAPB联合应用于经腹全子宫切除术可有效降低疼痛介质释放,缓解患者术后疼痛,提高患者术后舒适度,且安全性好。

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关键词 ：超声引导下腹横肌平面阻滞, 帕瑞昔布钠, 全子宫切除术, 镇痛, 疼痛介质

Abstract：Objective:To investigate the effect of ultrasound-guided transverse abdominal plane block (TAPB) combined with parecoxib sodium (PCX) for postoperative analgesia after gynaecological total hysterectomy and the effect on pain mediators. Methods:Eighty patients who underwent elective transabdominal total hysterectomy in our hospital from 07/2018 to 11/2021 were selected and divided into two groups of 40 patients each by simple random grouping, with the control group given TAPB compound general anesthesia and the study group given PCX on top of the control group. anesthesia was observed in both groups, and patients' levels of prostaglandin E2 (PGE2), substance P (SP), β-endorphin (β-EP), pentraxin (5-HT) and other pain mediators were measured at admission (preoperative), 6h postoperative, 12h postoperative, and 24h postoperative. (PGE2), substance P (SP), β-endorphin (β-EP), pentraxin (5-HT) and other pain mediators at the time of admission (preoperative); 6h postoperative, 12h postoperative and 24h postoperative, and pain at the time of discharge; 6h postoperative, 12h postoperative and 24h postoperative was assessed using the comfort score (BCS) and visual analogue scale (VAS).Results: In the study group, the dosage of remifentanil was significantly less than that of the control group, and the time for recovery of spontaneous breathing, awakening, first anal discharge and bed movement was significantly shorter than that of the control group (P<0.05); the levels of PGE2, SP, β-EP and 5-HT gradually increased after surgery and gradually decreased after reaching the peak at 6h postoperatively, and the levels of PGE2, SP and 5-HT in the study group were significantly lower than those in the control group at 6h, 12h and 24h postoperatively (P<0.05). The VSA score gradually increased after leaving the room, and the levels of PGE2, SP and 5-HT in the study group were significantly lower than those in the control group at 6h, 12h and 24h postoperatively (P<0.05); the BCS score gradually decreased after surgery, and the levels of PGE2, SP and 5-HT in the study group were significantly higher than those in the control group at 6h, 12h and 24h postoperatively (P<0.05); the BCS score gradually decreased after surgery, and the levels of β-EP in the study group were significantly higher than those in the control group at 6h, 12h and 24h postoperatively (P<0.05). The incidence of adverse reactions was not statistically different between the two groups (P>0.05).Conclusion: The combined application of PCX and TAPB in transabdominal total hysterectomy can effectively reduce the release of pain mediators, relieve patients' postoperative pain and improve their postoperative comfort with good safety.

Key words： Ultrasound guided transversus abdominis plane block Parecoxib sodium Total hysterectomy Analgesia Pain mediator

基金资助:安徽省重点研究与开发计划立项项目,(编号:201904a07020119)

通讯作者: 程贞永

引用本文:

谢红, 邓国魁, 胡波, 程贞永. 帕瑞昔布钠预防性镇痛联合超声引导下腹横肌平面阻滞用于妇科全子宫切除术后镇痛的效果[J]. 河北医学, 2022, 28(4): 644-648.
XIE Hong, DENG Guokui, HU Bo, et al. Effectiveness of Parecoxib Sodium Prophylactic Analgesia Combined with Ultrasound-Fuided Transversus Abdominis Plane Block for Postoperative Analgesia After Gynecological Total Hysterectomy. HeBei Med, 2022, 28(4): 644-648.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2022.04.023 或 http://www.hbyxzzs.cn/CN/Y2022/V28/I4/644

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