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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2022, Vol. 11 ›› Issue (04): 395 -400. doi: 10.3877/cma.j.issn.2095-3232.2022.04.014

临床研究

帕瑞昔布联合罗哌卡因在腹腔镜胆囊切除术后早期镇痛中的疗效
邬杰忠1, 柯春连1, 李宇翠1, 谭雷2, 黄河1, 熊志勇1, 梁豪1, 张鹏1, 王庆亮1, 许世磊1, 林继宗1, 胡昆鹏1, 姚志成1, 刘波1,†()   
  1. 1. 510630　广州，中山大学附属第三医院岭南医院普通外科
    2. 510630　广州，中山大学附属第三医院岭南医院超声科
  • 收稿日期:2022-03-31 出版日期:2022-08-10
  • 通信作者: 刘波
  • 基金资助:
    国家自然科学基金(81572726); 广东省自然科学基金(2018A030313641)

Efficacy of parecoxib combined with ropivacaine in early analgesia after laparoscopic cholecystectomy

Jiezhong Wu1, Chunlian Ke1, Yucui Li1, Lei Tan2, He Huang1, Zhiyong Xiong1, Hao Liang1, Peng Zhang1, Qingliang Wang1, Shilei Xu1, Jizong Lin1, Kunpeng Hu1, Zhicheng Yao1, Bo Liu1,†()   

  1. 1. Department of General Surgery, Lingnan Hospital, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
    2. Department of Ultrasound, Lingnan Hospital, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
  • Received:2022-03-31 Published:2022-08-10
  • Corresponding author: Bo Liu
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目的

探讨帕瑞昔布联合罗哌卡因在腹腔镜胆囊切除术（LC）术后镇痛的安全性和疗效。

方法

本前瞻性研究对象为2020年7月至2021年6月在中山大学附属第三医院岭南医院行LC的100例胆囊良性疾病患者。患者均签署知情同意书，符合医学伦理学规定。其中男44例，女56例；年龄24~77岁，中位年龄43岁。采用随机数字表法将患者分为实验组与对照组，每组各50例。实验组术前10 min静注帕瑞昔布40 mg，手术结束缝皮前给予罗哌卡因皮下浸润麻醉；对照组给予同等容量生理盐水。记录患者术后疼痛视觉模拟评分（VAS）及镇痛药使用情况，观察围手术期情况及并发症发生情况等。

结果

实验组术后l、6、12 h静态VAS分别为（2.0±0.7）、（2.2±0.4）、（1.1±0.2）分，明显低于对照组的（3.7±0.4）、（3.6±0.4）、（2.2±0.3）分（t=-2.192，-2.257，-2.811；P<0.05）。实验组术后l、6、12、24 h动态VAS分别为（2.7±0.6）、（3.1±0.2）、（2.1±0.4）、（1.3±0.1）分，明显低于对照组的（4.4±0.4）、（4.7±0.4）、（3.2±0.3）、（2.5±0.2）分（t=-2.427，-3.424，-2.454，-4.417；P<0.05）。实验组术后首次下床时间为（8.5±0.5）h，明显早于对照组的（10.5±0.7）h（t=-2.307，P<0.05)；住院时间为（5.3±0.3）d，明显短于对照组的（7.3±0.8）d（t=-2.292，P<0.05）。实验组术后使用镇痛药4例，明显少于对照组的13例（χ2=5.740，P<0.05）。两组均无术后伤口感染、腹腔感染、腹腔出血、呼吸抑制等并发症发生。实验组术后12 h的WBC、C-反应蛋白和IL-6分别为（10.0±1.1）×109/L、（37.4±7.2）mg/L、（56.4±8.7）ng/L，明显低于对照组的（14.2±1.5）×109/L、（65.1±6.9）mg/L、（80.9±6.1）ng/L（t=-2.163，-2.778，-2.314；P<0.05）。

结论

帕瑞昔布联合罗哌卡因在LC术后早期镇痛中效果明显，可减轻应激反应，促进术后快速康复，是一种简单、安全、有效的术后镇痛方法。

关键词: 胆囊切除术，腹腔镜, 镇痛, 麻醉药，全身, 麻醉药，局部, 帕瑞昔布, 罗哌卡因
Objective

To evaluate the safety and efficacy of parecoxib combined with ropivacaine in early analgesia after laparoscopic cholecystectomy (LC).

Methods

In this prospective study, 100 patients with benign gallbladder diseases underwent LC in Lingnan Hospital, the Third Affiliated Hospital ofSun Yat-sen University from July 2020 to June 2021 were recruited. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 44 patients were male and 56 female, aged from 24 to 77 years, with a median age of 43 years. All patients were divided into the study group (n=50) and control group (n=50) according to the random number table method. Patients in the study group were given intravenous injection of 40 mg parecoxib at 10 min before surgery, and subcutaneous infiltration anesthesia of ropivacaine was delivered before suturing. In the control group, an equivalent quantity of normal saline was delivered. The visual analogue scale (VAS) score of postoperative pain and use of analgesics were recorded. The perioperative conditions and complications was observed.

Results

In the study group, the static VAS scores at postoperative 1, 6 and 12 h were 2.0±0.7, 2.2±0.4 and 1.1±0.2, significantly lower than 3.7±0.4, 3.6±0.4 and 2.2±0.3 in the control group (t=-2.192, -2.257, -2.811; P<0.05). At l, 6, 12 and 24 h after operation, the dynamic VAS scores in the study group were 2.7±0.6, 3.1±0.2, 2.1±0.4 and 1.3±0.1, significantly lower than 4.4±0.4, 4.7±0.4, 3.2±0.3 and 2.5±0.2 in the control group (t=-2.427, -3.424, -2.454, -4.417; P<0.05). The first off-bed activity time in the study group was (8.5±0.5) h, significantly earlier than (10.5±0.7) h in the control group (t=-2.307, P<0.05). In the study group, the length of hospital stay was (5.3±0.3) d, significantly shorter than (7.3±0.8) d in the control group (t=-2.292, P<0.05). In the study group, analgesics were used in 4 cases after operation, significantly less than 13 cases in the control group ( χ2=5.740, P<0.05). No postoperative wound infection, abdominal infection, abdominal hemorrhage, respiratory depression and other complications occurred in both groups. At postoperative 12 h, WBC, C-reactive protein and IL-6 in the study group were (10.0±1.1)×109/L, (37.4±7.2) mg/L and (56.4±8.7)ng/L, significantly lower than (14.2±1.5)×109/L, (65.1±6.9) mg/L and (80.9±6.1) ng/L in the control group (t=-2.163, -2.778, -2.314; P<0.05).

Conclusions

Parecoxib combined with ropivacaine is a simple, safe and effective analgesia approach after LC, which can yield high efficacy, mitigate stress reaction and accelerate postoperative recovery.

Key words: Cholecystectomy, laparoscopic, Analgesia, Anesthetics, general, Anesthetics, local, Parecoxib, Ropivacaine
表1 实验组和对照组患者LC术前一般资料比较
组别 例数 性别（例） 年龄（岁，±s） AST（U/L，±s） ALT（U/L，±s） TB（μmol/L，±s） DB（μmol/L，±s） Scr（μmol/L，±s）
男 女
实验组 50 24 26 41±4 18.1±1.0 16.9±1.7 11.7±0.9 5.0±1.2 77±4
对照组 50 20 30 45±5 23.0±3.8 28.2±8.5 11.7±1.3 4.0±0.9 75±4
统计值   χ2=0.649 t=-0.595 t=-1.134 t=-1.150 t=-0.007 t=0.635 t=0.218
P值   ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＞0.05
表2 实验组和对照组患者LC术后VAS比较（±s）
组别 例数 静态 动态
术后1 h 术后6 h 术后12 h 术后24 h 术后48 h 术后1 h 术后6 h 术后12 h 术后24 h 术后48 h
实验组 50 2.0±0.7 2.2±0.4 1.1±0.2 0.6±0.2 0.4±0.2 2.7±0.6 3.1±0.2 2.1±0.4 1.3±0.1 1.1±0.1
对照组 50 3.7±0.4 3.6±0.4 2.2±0.3 1.0±0.3 0.6±0.2 4.4±0.4 4.7±0.4 3.2±0.3 2.5±0.2 1.5±0.2
t值   -2.192 -2.257 -2.811 -1.238 -0.762 -2.427 -3.424 -2.454 -4.417 -1.675
P值   ＜0.05 ＜0.05 ＜0.05 ＞0.05 ＞0.05 ＜0.05 ＜0.05 ＜0.05 ＜0.05 ＞0.05
表3 实验组和对照组患者LC术后恢复及镇痛药使用情况比较
组别 例数 手术时间（h，±s） 首次下床时间（h，±s） 住院时间（d，±s） 首次镇痛时间（h，±s） 恶心呕吐（例） 镇痛例数（例） 镇痛药总量(mg)
实验组 50 1.4±0.1 8.5±0.5 5.3±0.3 4.9±2.1 11 4 300
对照组 50 1.3±0.1 10.5±0.7 7.3±0.8 6.8±1.4 15 13 975
统计值   t=0.347 t=-2.307 t=-2.292 t=-0.757 χ2=0.832 χ2=5.740 -
P值   ＞0.05 ＜0.05 ＜0.05 ＜0.05 ＞0.05 ＜0.05 -
表4 实验组和对照组患者LC术前及术后12 h应激反应比较（±s）
组别 例数 WBC（×109/L） CRP（mg/L） IL-6（ng/L）
术前 术后12 h 术前 术后12 h 术前 术后12 h
实验组 50 6.0±0.4 10.0±1.1 17±5 37±7 10.6±2.8 56.4±8.7
对照组 50 7.1±0.6 14.2±1.5 20±7 65±7 12.1±3.8 80.9±6.1
t值   -1.479 -2.163 -0.404 -2.778 -0.324 -2.314
P值   ＞0.05 ＜0.05 ＞0.05 ＜0.05 ＞0.05 ＜0.05
表5 实验组和对照组LC术后肝肾功能比较（±s）
组别 例数 AST（U/L） ALT（U/L） TB（μmol/L） DB（μmol/L） Scr（μmol/L）
实验组 50 22.9±2.5 23.2±3.0 15.1±1.9 6.1±1.0 76±4
对照组 50 28.3±2.3 33.8±6.0 16.3±2.5 5.2±1.2 75±4
t值   -1.602 -1.471 -0.358 0.528 0.234
P值   ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＞0.05
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