泌尿外科手术围手术期应用帕瑞昔布钠镇痛在加速康复外科中的研究

叶冬晖; 刘玲; 马莉; 杨秋香; 王志红; 彭胤琼; 廖艳; 李虹; 王坤杰

doi:10.13201/j.issn.1001-1420.2021.08.012

泌尿外科手术围手术期应用帕瑞昔布钠镇痛在加速康复外科中的研究

- 四川大学华西医院泌尿外科(成都, 610041)
基金项目:
四川大学华西医院学科卓越发展1·3·5工程项目(No:ZYGD18011)

详细信息

通讯作者: 王坤杰,E-mail:wangkj@scu.edu.cn

中图分类号: R69

收稿日期: 2020-08-21

Perioperative application of parecoxib sodium in urological surgery for enhanced recovery after surgery

- Department of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China

More Information

Corresponding author: WANG Kunjie, E-mail: wangkj@scu.edu.cn

Received Date: 21 August 2020

摘要

摘要: 目的:围手术期镇痛是加速康复外科(enhanced recovery after surgery,ERAS)的重要组成部分。本研究观察泌尿外科各类手术分别于围手术期应用帕瑞昔布钠镇痛和传统术后按需使用阿片类药物的效果,以对比2种镇痛方案在泌尿外科手术康复管理中的应用,并评估其在ERAS中的应用效果。方法:选取2016年8月—2018年4月我院泌尿外科收治的各类手术患者279例,用随机数字表将患者分为围手术期帕瑞昔布钠镇痛组(研究组)和术后阿片类药物按需镇痛组(对照组),分析两组患者术后疼痛评分、不良反应、追加镇痛次数、住院天数、以及术后各类康复时间。结果:术后疼痛评分显示,研究组术后6 h、24 h、48 h、72 h的疼痛评分均低于对照组,48 h前两组比较差异有统计学意义(P＜0.001,P＜0.001,P=0.003,P=0.121)。研究组术后追加使用阿片类药物解救7次,对照组术后追加阿片解救65次,研究组出现术后恶心和呕吐发生率均显著低于对照组(3.13%vs.9.27%,P=0.037;0.78%vs.5.30%,P=0.033)。术后各类康复时间分析显示,研究组患者术后第1次排气时间和进食时间显著低于对照组[(1.59±1.08) d vs.(2.13±1.07) d,P＜0.001;(1.93±1.10) d vs.(1.56±1.11) d,P=0.005],第1次下床时间和手术后住院时间差异无统计学意义(P=0.996,P=0.990)。术型亚组分析发现,腹腔镜手术和尿道重建手术研究组术后排气时间和进食时间较对照组有显著优势(P＜0.001,P=0.013;P=0.001,P＜0.001),开放性手术和经尿道前列腺手术的排气时间和进食时间比较差异无统计学意义(P＞0.05)。结论:泌尿外科手术患者围手术期应用帕瑞昔布钠镇痛方案的效果良好,可减少阿片类药物的使用,不良反应率低,且在缩短术后肠道功能康复时间上有一定优势。
- 泌尿外科 /
- 加速康复外科 /
- 帕瑞昔布钠
Abstract: Objective: The management of perioperative pain is an important part of enhanced recovery after surgery(ERAS). The present study was to investigate the effects of perioperative analgesia with parecoxib sodium or traditional postoperative on-demand use of opioids in various urological surgeries, in order to compare the applications of two analgesic strategies in rehabilitation management and to evaluate their effects in ERAS.Methods: A total of 279 patients undergoing urological surgery in our hospital from August 2016 to April 2018 were enrolled. The patients were randomly divided into the parecoxib sodium group(study group) and the on-demand opioids analgesia group(control group). Postoperative pain scores, adverse reactions, additional analgesia, length of hospital stay, and postoperative recovery time were analyzed in both groups.Results: Analysis of postoperative pain scores showed that the pain scores of the study group at 6 h, 24 h, 48 h, and 72 h after surgery were lower than those of the control group, and the difference was statistically significant before 48 h(P＜0.001, P＜0.001, P=0.003, P=0.121). In the study group, 7 times additional opioids were used after surgery, while in the control group, 65 times additional opioids were used. The incidence of postoperative nausea and vomiting in the study group were significantly lower than those in the control group(3.13% vs. 9.27%, P=0.037; 0.78% vs. 5.30%, P=0.033). Analysis of postoperative recovery times showed that the first exhaust time and feeding time in the study group were significantly lower than those in the control group[(1.59±1.08) d vs.(2.13±1.07) d, P＜0.001;(1.93±1.10) d vs.(1.56±1.11) d, P=0.005]. There was no significant difference in the time of getting out of bed or the length of hospital stay after the operation(P=0.996, P=0.990). Subgroup analysis of operation type found that the study group of laparoscopic surgery and urethral reconstruction surgery had significant advantages in postoperative exhaust time and eating time compared with the control group(P＜0.001, P=0.013; P=0.001, P＜0.001). In open surgery and transurethral prostate surgery, there was no statistically significant difference in exhaust time or feeding time(P＞0.05).Conclusion: The perioperative application of parecoxib sodium in urological patients has a good effect, which can reduce the use of opioids with a low adverse reaction rate, and has advantages in shortening the postoperative recovery time of the intestinal function.
- urology /
- enhanced recovery after surgery /
- parecoxib sodium

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