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急性高容量血液稀释对帕瑞昔布钠超前镇痛作用的影响
Effects of acute hypervolemic hemodilution on parecoxib preemptive analgesia
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DOI:
作者:
沙勤
SHA Qin
作者单位:
中山医院青浦分院
Department of Anesthesiology, Qingpu Branch of Zhonshan Hospital, Fudan University
关键词:
急性高容量血液稀释;帕瑞昔布钠;超前镇痛
Acute hypervolemic hemodilution; Parecoxib; Preemptive analgesia
摘要:
目的 探讨急性高容量血液稀释对帕瑞昔布钠超前镇痛作用的影响。 方法 择期妇科开腹手术全麻患者60例,年龄29-55岁,ASAI或II级,随机分为3组(n=20):帕瑞昔布组(A组)、帕瑞昔布+高容量血液稀释组(B组)、对照组(C组)。患者入手术室后,A组静脉注射帕瑞昔布钠40mg并输注乳酸钠林格氏液10ml/kg;B组静脉注射帕瑞昔布钠40mg并输注羟乙基淀粉(6%,130/0.4)15ml/kg;C组输注乳酸钠林格氏液10ml/kg。各组液体均于30min内输注完毕,然后以异丙酚和瑞芬太尼静脉靶控输注,设定血浆浓度分别为3µg/ml和3ng/ml,维库溴铵0.12mg/kg静注进行麻醉诱导。在关腹前给予芬太尼2µg/kg。拔管后进行VAS评分,>5分者则追加芬太尼0.5µg/kg,每隔20min评估一次,直至术毕2h。分别在患者入手术室(T0)、插管前(T1)、划皮后(T2)、术毕即刻(T3)、术毕2h(T4)记录心率(HR)、平均动脉压(MAP)、熵指数(Entropy)的变化。并在各时点测定血清白细胞介素-6(IL-6)、肿瘤坏死因子-ɑ(TNF-ɑ)水平,在T0、T2时测定血常规各指标。 结果 B组在T2时的红细胞(RBC)、血红蛋白(Hb)、红细胞压积(Hct)水平显著低于T0时(P值均<0.05),并且显著低于同时点A组和C组的水平(P值均<0.05)。IL-6血浆浓度在T4时,A组和B组显著低于C组(P值均<0.05),且A组显著低于B组(P值均<0.05)。拔管后的VAS评分及术毕2h内芬太尼追加量C组均显著高于A组和B组(P值均<0.05),并且B组也显著高于A组(P值均<0.05)。 结论 急性高容量血液稀释对帕瑞昔布钠的超前镇痛有一定的削弱作用。
Objective To investigate the effects of acute hypervolemic hemodilution on parecoxib preemptive analgesia. Methods Sixty ASA I or II patients aged 29-55 yr undergoing elective gynecologic laparotomy under general anesthesia were randomly divided into 3 groups(n=20): group A parecoxib; group B parecoxib+acute hypervolemic hemodilution and group C control. The patients were given parecoxib 40mg (in group A and B) or saline 5ml(in group C)when they came into the operation room, and then received lactated Ringer's solution 10ml/kg (in group A and C) or hydroxyethyl starch (6% HES 130/0.4) (in group B).AHH was conducted by infusion of hydroxyethyl starch(6% HES 130/0.4)15mg/kg in 30min. Anesthesia was induced by target-controlled infusion(TCI) of propofol 3µg/ml and remifentanyl 3ng/ml. Tracheal intubation was facilitated with vecuronium 0.12mg/kg. The patients were given fentanyl 2µg/kg before closing the peritoneum. After extubation, we scored the patients with visual analogue scale. If more than 5, the patients were given fentanyl 0.5µg/kg every 20minutes until 2hours after operation. HR, MAP, Entropy were continuously monitored and recorded at entering the operating room(T0), immediately before intubation(T1), immediately after incision(T2), immediately after operation(T3), and 2 hours after operation(T4). The plasma levels of IL-6 and TNF-ɑ were determined at all these times by using radioimmunoassay. The routine blood tests were done at T0, T2. Results The values of RBC, Hb and Hct in group B were significantly decreased at T2 than at T0(P<0.05). The plasma levels of IL-6 were significantly lower at T4 in group A and B than in group C(P<0.05), also they were significantly lower in group A than in group B(P<0.05). The scores of VAS at 10minutes after extubation were significantly higher in group C than in group A and B(P<0.05), as well as the total fentanyl consumption in 2 hours after operation(P<0.05). And also they were significantly higher in group B than in group A(P<0.05). Conclusion The acute hypervolemic hemodilution can attenuate the effect of parecoxib preemptive analgesia.
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