氢吗啡酮联合帕瑞昔布在食管癌根治术中的超前镇痛效果

The preemptive analgesic effect of hydromorphone combined with parecoxib in radical esophagectomy for esophageal cancer

摘要:

目的 探究氢吗啡酮联合帕瑞昔布在食管癌根治术中的超前镇痛效果。方法 选取2022年11月—2024年11月在榆林市中医医院行食管癌根治术的106例患者为研究对象，按麻醉方法分为氢吗啡酮组、联合组，各53例。氢吗啡酮组予以氢吗啡酮超前镇痛，联合组予以氢吗啡酮超前镇痛联合帕瑞昔布，比较两组临床资料、不同时间点心率（HR）、平均动脉压（MAP）、镇痛效果、应激反应及不良反应。结果 联合组自主呼吸恢复时间、苏醒时间、瑞芬太尼用量、按压镇痛泵次数均低于氢吗啡酮组（P <0.05）。联合组与氢吗啡酮组入室、气管插管、切皮5 min、术毕时的HR、MAP比较，结果 ①不同时间点HR、MAP比较，差异均有统计学意义（P <0.05）；②联合组与氢吗啡酮组HR、MAP比较，差异均有统计学意义（P <0.05）；③两组HR、MAP变化趋势比较，差异均有统计学意义（P <0.05）。联合组与氢吗啡酮组术后3、12和24 h的视觉模拟评分法（VAS）评分比较，结果 ①不同时间点VAS评分比较，差异有统计学意义（P <0.05）；②联合组与氢吗啡酮组VAS评分比较，差异有统计学意义（P <0.05）；③两组VAS评分变化趋势比较，差异有统计学意义（P <0.05）。联合组治疗前后促肾上腺皮质激素、去甲肾上腺素、皮质醇的差值均小于氢吗啡酮组（P <0.05）。两组不良反应总发生率比较，差异无统计学意义（P >0.05）。结论 氢吗啡酮超前镇痛联合帕瑞昔布在食管癌根治术中能有效改善围手术期指标、维持血流动力学稳定、减轻术后疼痛及应激激素水平，且安全性良好。

Abstract:

Objective To investigate the preemptive analgesic effect of hydromorphone combined with parecoxib in radical esophagectomy for esophageal cancer.Methods A total of 106 patients undergoing radical esophagectomy at our hospital from November 2022 to November 2024 were selected. They were divided into a hydromorphone group (n = 53) and a combination group (n = 53) based on anesthesia methods. The hydromorphone group received preemptive analgesia with hydromorphone alone, while the combination group received preemptive analgesia with hydromorphone combined with parecoxib. Clinical data, heart rate (HR) and mean arterial pressure (MAP) at different time points, analgesic effects, stress responses, and adverse reactions were compared between the two groups.Results The combination group exhibited shorter spontaneous breathing recovery time, awakening time, lower remifentanil consumption, and fewer patient-controlled analgesia pump presses than the hydromorphone group (P < 0.05). A comparison of HR and MAP between the combination group and the hydromorphone group at the time of entering the operating room, tracheal intubation, 5 minutes after skin incision, and at the end of surgery showed that HR and MAP were different across the time points (P < 0.05) and between the combination group and the hydromorphone group (P < 0.05), and that the change trends of HR and MAP were also different between the two groups (P < 0.05). A comparison of Visual Analogue Scale (VAS) scores between the combination group and the hydromorphone group at 3, 12, and 24 hours after surgery showed that VAS scores differed across the time points (P < 0.05) and between the combination group and the hydromorphone group (P < 0.05), and that the change trends of VAS scores also differed between the two groups (P < 0.05). The differences in adrenocorticotropic hormone, norepinephrine, and cortisol levels before and after treatment in the combination group were smaller than those in the hydromorphone group (P < 0.05). There was no statistically significant difference in the overall incidence of adverse reactions between the two groups (P > 0.05).Conclusion Preemptive analgesia with hydromorphone combined with parecoxib during radical esophagectomy for esophageal cancer effectively improves perioperative parameters, maintains hemodynamic stability, reduces postoperative pain and stress hormone levels, and demonstrates good safety.