依托考昔结合腰椎麻醉在开放性腹股沟疝修补术后镇痛的研究

doi:10.3877/cma.j.issn.1674-392X.2020.01.009

目的

探讨术前应用依托考昔对开放性腹股沟疝修补术患者术后疼痛控制的影响。

方法

选择2016年1月至2018年9月，惠州市第六人民医院60例接受开放性腹股沟疝修补术的老年患者的临床资料并进行单中心、随机、双盲、安慰剂对照试验。试验组患者30例，术前1 h接受120 mg口服依托考昔；对照组患者30例，术前1 h口服安慰剂，采用布比卡因进行腰椎麻醉。记录并分析静息时术后疼痛视觉模拟评分（VAS）。记录患者第1次按需镇痛的时间、术后24 h内镇痛剂量补充次数及术后24 h内吗啡的镇痛剂量及术后不良反应事件发生情况。

结果

试验组的术后4、8、12、16和24 h VAS评分分别为（2.47±1.33）分、（2.50±1.74）分、（2.63±1.22）分、（3.37±0.67）分、（2.67±1.14）分，试验组分别为（3.03±1.30）分、（3.70±1.86）分、（4.27±1.68）分、（3.83±1.70）分、（2.93±1.11）分，2组患者组间相同时间VAS评分比较，差异有统计学意义（F_组间=34.130，P_组间<0.001）；2组患者组内不同时间点VAS评分比较，差异有统计学意义（F_时间=8.875，P_时间<0.001）；2组患者组间不同时间VAS评分比较，差异有统计学意义（F_交互=5.234，P_交互=0.001）。试验组患者第1次按需镇痛的时间为（178.20±41.45）min，显著高于对照组（142.80±61.75）min；试验组术后24 h内镇痛剂量补充次数、术后24 h内吗啡的镇痛剂量分别为（2.67±0.96）次、（7.40±4.28）mg，显著低于对照组的（3.43±1.48）次、（11.20±6.17）mg，差异均有统计学意义（P<0.05）。试验组术后出血尿潴留患者2例，胃肠道反应患者3例；对照组术后出血尿潴留患者1例，胃肠道反应患者1例，差异无统计学意义（χ²=0.647，P=0.421）。

结论

依托考昔联合腰椎麻醉可以改善老年开放性腹股沟疝修补术患者的术后疼痛。

关键词: 疝, 腹股沟, 依托考昔, 术后镇痛

Objective

To investigate the effect of preoperative etoricoxib on postoperative pain control in patients with open inguinal hernia repair.

Methods

From January 2016 to September 2018, clinical data of 60 elderly patients undergoing open inguinal hernia repair in the Sixth People's Hospital of Huizhou were selected and a single-center, randomized, double-blind, placebo-controlled trial were performed. Thirty patients in the test group received 120 mg of oral etoricoxib 1 h before surgery; 30 patients in the control group received oral placebo 1 h before surgery and used bupivacaine for lumbar spinal anesthesia. Record and analyze postoperative visual analog score at rest. Record whether the patient required supplemental analgesia, the number of analgesics given, the total dose, and the postoperative adverse reactions within 24 hours.

Results

The visual analogue scores of pain in the experimental group at 4, 8, 12, 16, and 24 hours were (2.47±1.33) scores, (2.50±1.74) scores, (2.63±1.22) scores, (3.37±0.67) scores, and (2.67±1.14) scores, respectively. The visual analogue scores for pain at 8, 12, 16, and 24 hours were (3.03±1.30) scores, (3.70±1.86) scores, (4.27±1.68) scores, (3.83±1.70) scores, and (2.93±1.11) scores. The test groups were significantly lower than the control group, and the differences were statistically significant (P<0.05). Patients in the test group needed supplemental analgesia for (178.20±41.45) minutes, which was significantly higher than that in the control group (142.80±61.75) minutes. The number of analgesic dose supplements and doses in the experimental group within 24 hours were (2.67±0.96) times, (7.40±4.28) mg, which was significantly lower than (3.43±1.48) times and (11.20±6.17) mg of the control group, and the differences were statistically significant (P<0.05). There was no significant difference in the incidence of adverse events between the two groups (P>0.05).

Conclusion

Etoricoxib combined with lumbar spinal anesthesia can improve the pain of elderly patients with open inguinal hernia repair.

Key words: Hernia, inguinal, Etoricoxib, Postoperative analgesia

表1 试验组和对照组老年腹股沟疝无张力修补术患者一般资料比较

组别	例数	年龄(岁,±s)	体重(kg,±s)	体质量指数(kg/m²,±s)	美国麻醉师协会分级(Ⅱ/Ⅲ级)[例(%)]	手术时间(min,±s)	麻醉持续时间(min,±s)
对照组	30	67.83±4.89	70.97±4.62	22.65±3.08	23(76.67)	54.12±15.88	133.62±16.41
试验组	30	66.73±3.82	69.53±3.98	21.60±2.66	25(83.33)	49.10±13.87	128.30±17.78
检验值		t=0.970	t=1.285	t=1.413	χ²=0.417	t=1.299	t=1.200
P值		0.336	0.204	0.163	0.748	0.199	0.235

表1 试验组和对照组老年腹股沟疝无张力修补术患者一般资料比较

组别	例数	年龄(岁,±s)	体重(kg,±s)	体质量指数(kg/m²,±s)	美国麻醉师协会分级(Ⅱ/Ⅲ级)[例(%)]	手术时间(min,±s)	麻醉持续时间(min,±s)
对照组	30	67.83±4.89	70.97±4.62	22.65±3.08	23(76.67)	54.12±15.88	133.62±16.41
试验组	30	66.73±3.82	69.53±3.98	21.60±2.66	25(83.33)	49.10±13.87	128.30±17.78
检验值		t=0.970	t=1.285	t=1.413	χ²=0.417	t=1.299	t=1.200
P值		0.336	0.204	0.163	0.748	0.199	0.235

表2 试验组和对照组老年腹股沟疝无张力修补术患者疼痛视觉模拟评分比较（分，±s）

组别	例数	术后4 h	术后8 h	术后12 h	术后16 h	术后24 h
试验组	30	2.47±1.33	2.50±1.74	2.63±1.22	3.37±0.67	2.67±1.14
对照组	30	3.03±1.30	3.70±1.86	4.27±1.68	3.83±1.70	2.93±1.11
F值		F_组间=34.130，F_时间=8.875，F_交互=5.234
P值		P_组间<0.001，P_时间<0.001，P_交互=0.001

表2 试验组和对照组老年腹股沟疝无张力修补术患者疼痛视觉模拟评分比较（分，±s）

组别	例数	术后4 h	术后8 h	术后12 h	术后16 h	术后24 h
试验组	30	2.47±1.33	2.50±1.74	2.63±1.22	3.37±0.67	2.67±1.14
对照组	30	3.03±1.30	3.70±1.86	4.27±1.68	3.83±1.70	2.93±1.11
F值		F_组间=34.130，F_时间=8.875，F_交互=5.234
P值		P_组间<0.001，P_时间<0.001，P_交互=0.001

表3 试验组和对照组老年腹股沟疝无张力修补术患者术后镇痛管理数据比较（±s）

变量	例数	第1次按需镇痛的时间(min)	术后24 h内镇痛剂量补充次数(次)	术后24 h内吗啡的镇痛剂量(mg)
对照组	30	142.80±61.75	3.43±1.48	11.20±6.17
试验组	30	178.20±41.45	2.67±0.96	7.40±4.28
t值		-2.607	2.380	2.769
P值		0.012	0.020	0.008

表3 试验组和对照组老年腹股沟疝无张力修补术患者术后镇痛管理数据比较（±s）

变量	例数	第1次按需镇痛的时间(min)	术后24 h内镇痛剂量补充次数(次)	术后24 h内吗啡的镇痛剂量(mg)
对照组	30	142.80±61.75	3.43±1.48	11.20±6.17
试验组	30	178.20±41.45	2.67±0.96	7.40±4.28
t值		-2.607	2.380	2.769
P值		0.012	0.020	0.008

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Postoperative analgesic effect of etoricoxib in combination with spinal anesthesia in open inguinal hernia repair

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Postoperative analgesic effect of etoricoxib in combination with spinal anesthesia in open inguinal hernia repair