陈铁军

doi：10.3969/j.issn.1007-614x.2014.2.20

摘 要 目的：观察帕瑞昔布钠对胸腔镜患者全麻苏醒期寒战与躁动的作用。方法：全麻下择期行胸腔镜手术60例，随机分为帕瑞昔布钠组（P组）和芬太尼组（F组）各30例。手术结束前30分钟分别静注帕瑞昔布钠40mg、芬太尼0.05mg。观察全麻苏醒期寒战与躁动的发生及疼痛评分。结果：苏醒期寒战分级中P、F组差异无统计学意义（P>0.05）。躁动分级中0级的例数P组明显多于F组（P<0.05），1～3级的例数P组明显少于F组（P<0.01）。VAS评分0分患者例数P组明显多于F组（P<0.05），1～6分患者例数P组明显少于F组（P<0.01），躁动与疼痛有相关性。结论：帕瑞昔布钠可有效预防胸腔镜患者全麻苏醒期寒战与躁动的发生。

关键词 帕瑞昔布钠 胸腔镜 寒战 躁动

Prevention of parecoxib on shivering and restlessness of thoracoscope operation patients during recovery period of general anesthesia

Chen Tiejun

Inner Mongolia，Tongliao City Hospital，Department of Anesthesiology，028000

Abstract Objective：To observe the effect of parecoxib on shivering and restlessness of thoracoscope operation patients during recovery period of general anesthesia.Methods：60 patients who are underwent thoracoscope operation in the condition of general anesthesia were randomly divided into parecoxib sodium group（P group）and fentanyl group（F group）of 30 cases respectively.Patients of P group and F group were intravenous parecoxib sodium 40mg and fentanyl 0.05mg respectively 30 minutes before the surgery start.shivering and restlessness during recovery period of general anesthesia，and then observe the occurance and pain scores.Results：There were no statistically significant differences between P group and F group in shivering classification（P>0.05）.In the aspect of restlessness classification，the number of cases in 0 level of P group was more than those of F group（P<0.05），the number of cases in 1～3 level of P group was less than those of F group（P<0.01）.The number of cases in 0 VAS score of P group was more than those of F group（P<0.05），the number of cases in 1 to 6 VAS scores of P group was less than those of F group（P<0.01）.Restlessness is correlated with pain.Conclusion：Parecoxib may effectively prevent shivering and restlessness of thoracoscope operation patients during recovery period of general anesthesia.

Key words Parecoxib；Thoraeoseopes；Shivering；Restlessness

全麻术后疼痛是发生寒战和躁动的重要原因，可给患者带来不适和危害。阿片受体激动药芬太尼是有效的抗全麻术后寒战与躁动药物，同时也具有抑制呼吸功能的作用。帕瑞昔布钠是注射用高选择性COX-2抑制剂，具有良好的抗炎镇痛作用，对呼吸抑制轻，用于术后中重度急性疼痛治疗。本文探讨帕瑞昔布钠对胸腔镜患者全麻苏醒期寒战与躁动的预防作用，现报告如下。

资料与方法

选择全麻胸腔镜下择期行肺大泡、肺癌、纵膈肿瘤手术60例，年龄19～67岁，体重48～80kg，ASAⅠ或Ⅱ级。随机分为帕瑞昔布钠组（P组）和芬太尼组（F组）各30例。长期使用镇痛药物及有精神类疾病史患者不在讨论范围。

麻醉方法：两组术前30分钟均肌注射阿托品0.5mg。麻醉诱导静脉注射咪达唑仑2mg、舒芬太尼0.4μg/kg、依托咪酯2～4mg/kg、顺阿曲库铵0.2mg/kg，行气管插管。……