目的:探讨硬膜外患者自控镇痛(PCEA)-帕瑞昔布序贯镇痛联合改良Joel-Cohen切口用于腹腔镜肝左外叶切除术后镇痛的有效性.方法:2013年8月至2016年8月,40例肝肿瘤患者术后分为PCEA组(n=20)和PCEA-帕瑞昔布组(n=20).所有患者均行同一方式的腹腔镜肝左外叶切除术,取标本时均采用改良Joel-Cohen切口,术后PCEA组采用硬膜外镇痛(布比卡因300 mg+芬太尼500 μg+0.9%氯化钠液250 mL,4 mL/h泵入),PCEA-帕瑞昔布组采用PCEA-帕瑞昔布序贯镇痛(24 h内使用PCEA,24 h后停PCEA,改用帕瑞昔布镇痛40 mg静脉滴注,12 h/次×2 d).以视觉模拟评分法(visual analogue scale, VAS)比较两组术后镇痛效果,同时比较两组术后排气时间、下床活动时间、导尿管拔除时间、不良反应等.结果:术后1、6、12、24、48、72 h,PCEA组与PCEA-帕瑞昔布组患者静态VAS评分、动态VAS评分差异无统计学意义.PCEA-帕瑞昔布组术后排气时间短于PCEA组[(31±8.2) h vs (48±5.2) h],差异有统计学意义(P<0.001).PCEA-帕瑞昔布组下床活动时间短于PCEA组[(18±8.2) h vs (26±5.2)h],差异有统计学意义(P<0.001).PCEA-帕瑞昔布组尿管拔除时间短于PCEA组[(26±8.2) h vs (68±5.2) h],差异有统计学意义(P<0.001).PCEA组术后有2例发生恶心呕吐,1例发生低血压;PCEA-帕瑞昔布组1例发生恶心呕吐,无低血压发生.结论:腹腔镜肝左外叶切除术采用改良Joel-Cohen切口时,应用PCEA-帕瑞昔布序贯镇痛可达到与传统PCEA镇痛方案等效的镇痛效果,且术后恢复更快,镇痛相关不良反应发生率更少,值得临床推广.%Objective:To examine the efficacy of analgesia using sequential patient controlled epidural analgesia (PCEA)-parecoxib combined with modified Joel-Cohen incision for laparoscopic left lateral hepatectomy.Methods:From August 2013 to August 2016, 40 hepatocellular carcinoma (HCC) patients were enrolled and divided into PCEA group (n=20) and PCEA-parecoxib group (n=20).Patients in PCEA group received postoperative analgesia by using PCEA (bupivacaine 300 mg+fentanyl 500 μg+250 mL NS,4 mL/h pumping) , while those in PCEA-parecoxib group were subjected to PCEA and parecoxib (40 mg,iv,q12 h×2 d).The visual analog scale (VAS) was used to assess the degree of the postoperative pain.The times of bowel flatus, mobilisation, catheter withdrawal and adverse effects were compared.Results:There was no statistical significance of static VAS scores of PCEA group at 1 h、6 h、12 h、24、48 h and 72 h after surgery between two groups.The time of bowel flatus in PCEA-parecoxib group was (31±8.2) h, which was significantly shorter than that in PCEA group ([48±5.2] h, P<0.001).The time of mobilization in PCEA-parecoxib group was (18±8.2) h, which was also significantly shorter than that in PCEA group ([26±5.2] h, in PCEA group (P<0.001).Similarly, the time of catheter withdrawal in PCEA-parecoxib group was (26±8.2) h, which was significantly shorter than that in PCEA group ([68±5.2] h, P<0.001).There were 2 cases of nausea and vomiting and 1 case of hypotension in PCEA group while 1 case of nausea in PCEA-parecoxib group, and no incidence of hypotension.Conclusions:Analgesia using sequential PCEA-parecoxib combined with modified Joel-Cohen incision for laparoscopic left lateral hepatectomy is effective and equivalent to PCEA.It can facilitate a faster postoperative recovery and is worthy of wide application for laparoscopic left lateral hepatectomy.
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