山东大学耳鼻喉眼学报 ›› 2016, Vol. 30 ›› Issue (5): 49-53.doi: 10.6040/j.issn.1673-3770.0.2016.367

• 睡眠呼吸障碍性疾病 • 上一篇    下一篇

帕瑞昔布钠联合曲马多镇痛对悬雍垂腭咽成形术患者的影响

包扬1,王春玲1,张丽1,金敏1,周长青1,潘新良2   

  1. 山东大学齐鲁医院, 1.麻醉科;
    2.耳鼻咽喉头颈外科, 山东 济南 250012
  • 收稿日期:2016-08-19 出版日期:2016-10-20 发布日期:2016-10-20
  • 通讯作者: 王春玲. E-mail:2086260636@qq.com E-mail:youngboard@126.co
  • 作者简介:包扬. E-mail:youngboard@126.co

The effects of multimodal analgesia with parecoxib sodium and tramadol on patients treated with uvulopalatopharyngoplasty.

BAO Yang1, WANG Chunling1, ZHANG Li1, JIN Min1, ZHOU Changqing1, PAN Xinliang   

  1. 1. Department of Anesthesiology;2. Department of Otorhinolaryngology, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China
  • Received:2016-08-19 Online:2016-10-20 Published:2016-10-20

摘要: 目的 观察帕瑞昔布钠联合曲马多镇痛对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者行悬雍垂腭咽成形术(UPPP)后的镇痛效果、不良反应及炎性细胞因子水平的影响。 方法 将经多导睡眠仪(PSG)监测证实的60例OSAHS患者随机分为2个组,其中实验组(T组,30例)术前予帕瑞昔布钠联合曲马多镇痛,对照组(C组,30例)术前予曲马多镇痛,2个组UPPP术后均接受曲马多患者自控镇痛。统计2个组患者术后48 h内的疼痛视觉模拟评分(VAS),救援性镇痛药用量及不良反应发生率,并检测患者围手术期血清中肿瘤坏死因子α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)和细胞间黏附因子-1(ICAM-1)等炎性细胞因子的浓度。 结果 与C组相比,T组在术后48 h内的VAS评分降低(P<0.01),救援性镇痛药量减少(P<0.05),不良反应发生率降低(P<0.05)。T组患者血清TNF-α、IL-6浓度低于C组(P<0.01或P<0.05),而IL-10、ICAM-1浓度差异无统计学意义。 结论 帕瑞昔布钠联合曲马多镇痛用于OSAHS手术治疗术后镇痛效果良好,不良反应发生率低,并在一定程度上发挥抗炎作用,是UPPP围手术期较为理想的镇痛方法。

关键词: 悬雍垂腭咽成形术, 曲马多, 多模式镇痛, 帕瑞昔布钠, 炎性细胞因子

Abstract: Objective To observe the effects of multimodal analgesia with parecoxib sodium and tramadol on postoperative analgesia, incidence of adverse reactions and inflammatory factors in patients with obstructive sleep apnea-hypopnea syndrome(OSAHS)after uvulopalatopharyngoplasty(UPPP). Methods A total of 60 OSAHS cases were randomly divided the into the test group(T group, n=30, receiving parecoxib sodium and tramadol)and control group(C group, n=30, receiving tramadol only). Both groups received patient-controlled intravenous analgesia with tramadol after UPPP. Data of visual analog scale(VAS)for pain in 48 h postoperatively, rescue analgesic use and adverse reactions were collected. Inflammatory factors including TNF-α, IL-6, IL-10 and ICAM-1 were measured with ELISA. Results Lower VAS scores, less use of rescue analgesic and fewer adverse reactions were showed in T group(P<0.01, P<0.05, P<0.05). Decreased levels of TNF-α and IL-6 were found in T group(P<0.01, P<0.05), while there were no statistically significant differences in the levels of IL-10 and ICAM-1 between the two groups. Conclusion Multimodal analgesia with parecoxib sodium and tramadol can prolong the postoperative analgesia, demand less use of rescue analgesic, and cause fewer adverse reactions, which may play a positive role in the inhibition of inflammatory reaction after UPPP.

Key words: Uvulopalatopharyngoplasty, Parecoxib sodium, Tramadol, Inflammatory factors, Multimodal analgesia

中图分类号: 

  • R766.7
[1] Shamsuzzaman A S, Gersh B J, Somers V K. Obstructive sleep apnea: implications for cardiac and vascular disease[J]. JAMA, 2003, 290(14):1906-1914.
[2] 陈雄,孔维佳,肖英,等.改良等离子辅助下的悬雍垂腭咽成形术治疗重度OSAHS[J].临床耳鼻咽喉头颈外科杂志, 2011,25(20):929-932. CHEN Xiong, KONG Weijia, XIAO Ying, et al. Modified-coblation assisted UPPP in treatment of severe obstructive sleep apnea-hypopnea syndrome[J]. Clin J Otorhinolarynol Head Neck Surg, 2011, 25(20):929-932.
[3] 侯金程,王英,杨丽辉.低温等离子辅助下与传统改良悬雍垂腭咽成形术后不良反应的比较[J].中国耳鼻咽喉头颈外科,2014,21(12):659-660. HOU Jincheng, WANG Ying, YANG Lihui. Comparison of adverse reactions after plasma assisted uvulopalatopharyngoplasty and modified uvulopalatopharyngoplasty[J]. Chin J Ophthalmol Otorhinol, 2014, 21(12):659-660.
[4] American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Practice guidelines for the perioperative management of patients with obstructive sleep apnea: an updated report by the American Society of Anesthesiologists Task Force on perioperative management of patients with obstructive sleep apnea[J]. Anesthesiology, 2014, 120(2):268-286.
[5] Carev M, Karanovic N, Dogas Z. Obstructive sleep apnea and anesthesia[J]. Lijec Vjesn, 2008, 130(3-4):78-86.
[6] Schnoor J, Ilgner J, Hein M, et al. Perioperative management of patients with obstructive sleep apnoea[J]. Anaesthesist, 2009, 58(2):189-98.
[7] 中华医学会呼吸病学分会睡眠呼吸疾病学组.阻塞性睡眠呼吸暂停低通气综合征诊治指南(2011年修订版)[J].中华结核和呼吸杂志,2012,35(1):9-12.
[8] Jelic S, Lederer D J, Adams T. Vascular inflammation in obesity and sleep apnea[J]. Circulation, 2010, 121(8):1014-1021.
[9] Carpagnano G E, Spanevello A, Sabato R. Systemic and airway inflammation in sleep apnea and besity: the role of ICAM-1 and IL-8[J]. Transl Res, 2010, 155(1):35-43.
[10] 赵海燕,陈宝元,曹洁,等.阻塞性睡眠呼吸暂停模式间歇低氧对人脐静脉内皮细胞中内皮素-1、一氧化氮及一氧化氮合酶的影响[J].中华医学杂志,2007,87(31):2189-2192. ZHAO Haiyan, CHEN Baoyuan, CAO Jie, et al. Effects of obstructive sleep apnea style intermittent hypoxia on endothelin-1, nitric oxide, and nitric oxide synthase in endothelium: experiment with human umbilical vein endothelial cells[J]. Natl Med J Chin, 2007, 87(31):2189-2192.
[11] Shinji Tamaki, Motoo Yamauchi, Atsuhiko Fukuoka, et al. Production of Inflammatory Mediators by Monocytes in Patients with Obstructive Sleep Apnea Syndrome[J].Inter Med, 2009, 48(15):1255-1262.
[12] Somers V K, White D P, Amin R, et al. Sleep apnea and cardiovascular disease: an American Heart Association/American College of Cardiology Foundation Scientific Statement from the American Heart Association Councilfor High Blood Pressure Research Professional Education Committee, Council on clinical cardiology, stroke council, and council on cardiovascular nursing[J]. J Am Coil Cardiol, 2008, 52(8):686-717.
[13] Fletcher E C. Sympathetic over activity in the etiology of hypertension of obstructive sleep apnea[J]. Sleep, 2003, 26(1):15-19.
[14] 徐伟伟,李建东,刘春宁,等.改良悬雍垂腭咽成形术对阻塞性睡眠呼吸暂停低通气综合征患者血压、心律的影响[J].山东大学耳鼻喉眼学报,2013, 27(4):11-13. XU Weiwei, LI Jiandong, LIU Chunning, et al. Effects of H-UPPP on blood pressure and heart rhythm in OSAHS patients[J]. J Otolaryngol Ophthalmol Shandong Univ, 2013, 27(4):11-13.
[15] Stuck B A, Maurer J T. Recent developments in the diagnosis and treatment of obstructive sleep apnea: English version[J]. HNO, 2016, 64(2):75-81.
[16] 尹毅青,Frances Chung,廖埔,等.阻塞性睡眠呼吸暂停综合征患者咽腭成型术后缺氧发生的风险[J]. 中华麻醉学杂志,2013,33(04):406-408. YIN Yiqing, Frances Chung, LIAO Pu, et al. Risks of hypoxemia after uvulopalatopharyngoplasty in patients with obstructive sleep apnea syndrome[J]. Chin J Anesthesiol, 2013, 33(04):406-408.
[17] 李树华,暴继敏,石洪金,等.阻塞性睡眠呼吸暂停低通气综合征围手术期严重并发症的处理及预防[J].中华耳鼻咽喉头颈外科杂志,2010, 45(5):359-363. LI Shuhua, BAO Jimin, SHI Hongjin, et al. Treatment and prevention of serious peroperative complications of obstructive sleep apnea hypopnea syndrome[J]. Clin J Otorhinolarynol Head Neck Surg, 2010, 45(5):359-363.
[18] 赵抗美,安肖霞,吴英达,等. 阻塞性睡眠呼吸暂停综合征患者腭咽成形术的麻醉处理[J].中华麻醉学杂志,2005,25(9):707-708. ZHAO Kangmei, AN Xiaoxia, WU Yingda, et al. Anesthetic management of patients with obstructive sleep apnea syndrome[J]. Chin J Anesthesiol, 2005, 25(9):707-708.
[19] Kezirian E J, Weaver E M, Yueh B, et al. Incidence of serious complications after uvulopalatopharyngoplasty[J]. Laryngoscope, 2004, 114(3):450-453.
[20] Scott L J, Perry C M. Tramadol: a review of its use in perioperative pain[J]. Drugs, 2000, 60(1):139-176.
[21] Kumar A, Kumari B, Kumar P. Protective effects of selective and non-selective cyclooxygenase inhibitors in an animal model of chronic stress[J]. Neurosci Bull, 2010, 26(1):17-27.
[22] Zhang L, Shao D, Gu B, et al. Comparison of the effects of different analgesic methods after UPPP[J]. Clin J Otorhinolarynol Head Neck Surg, 2015, 29(11):991-993.
[23] Li B, Li Y M, Li X, et al. COX-2 inhibition improves immune system homeostasis and decreases liver damage in septic rats[J]. J Surg Res, 2009, 157(1):43-47.
[24] Fathali N, Ostrowski R P, Lekic T, et al. Cyclooxygenase-2 inhibition provides lasting protection against neonatal hypoxic-ischemic brain injury[J]. Crit Care Med, 2010, 38(2):572-578.
[25] Flórez A, de Haro J, Martínez E, et al. Selective cyclooxygenase-2 inhibition reduces endothelial dysfunction and improves inflammatory status in patients with intermittent claudication[J]. Rev Esp Cardiol, 2009, 62(8):851-857.
[26] 张焕康,肖宽林.鼻内糖皮质激素治疗儿童阻塞性睡眠呼吸暂停低通气综合征研究进展[J].中国眼耳鼻喉科杂志,2012,12(4):266-268. ZHANG Huankang, XIAO Kuanlin. Research progress of intranasal corticosteroids in the treatment of obstructive sleep apnea hypopnea syndrome in children[J]. Chin J Ophthalmol Otorhinol, 2012, 12(4):266-268.
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