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Effects of Different NSAIDs Combined with PICA on Postoperative Analgesia in Patients Undergoing
Gynecological Laparoscopic Surgery and Its Effect on Serum Related Factors
LI Shihuan ，LI Fan ，HUANG Yidi ，XU Zhixin（1. Dept. of Anesthesiology，the Second Affiliated Hospital of
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1
1
1
Hainan Medical University，Haikou 571100，China；2. Anatomy Teaching and Research Section，the First
Affiliated Hospital of Hainan Medical University，Haikou 570102，China）
ABSTRACT OBJECTIVE：To investigate the effects of parecoxib sodium，flurbiprofen axetil and lornoxicam combined with
patient controlled intravenous analgesia （PICA） on postoperative analgesia in patients undergoing gynecological laparoscopic
surgery and its effect on serum related factors. METHODS：A total of 280 patients who underwent gynecologic laparoscopic
surgery in the Second Affiliated Hospital of Hainan Medical University from Mar. 2017 to Mar. 2019 were randomly divided into
control group （group C），parecoxib sodium group （group P），and flurbiprofen axetil group （group F） and lornoxicam group
（group L）acording to random number table，with 70 patients in each group. Four groups of patients received Sodium chloride
injection 5 mL，Parecoxib sodium for injection 40 mg，Flurbiprofen axetil injection 50 mg and Lornoxicam for injection 8 mg
（added 8 mg when the effect was not good）intravenously at 30 min before the end of surgery. At the end of surgery，they were
given PICA of Sufentanil citrate injection and Dizosin injection for analgesia. The situation of pain and nausea symptom were
evaluated at 6，12，24 and 48 h after surgery by using numerical rating scale（NRS）. The levels of serum CRP，IL-6，SP and PGE2
were detected by chemiluminescence method and ELISA. The times of pressing PICA pump and the dosage of analgesic were
recorded in 4 groups within 24 h after surgery. The ADRs of patients within 48 h after surgery were recorded，such as bloating，
dizziness，itchy skin，respiratory depression and urinary retention. RESULTS：At different time points，the NRS scores of pain of
group P，F and L were significantly lower than those of group C；and 48 h after surgery，NRS score of pain of group L was
significantly lower than those of group P and F（P＜0.05）. There was no statistical significance in the level of CRP，IL-6，SP and
PGE2 of 4 groups before surger（P＞0.05）. The CRP，IL-6，SP and PGE2 levels at each time point after surgery of group P，F and
L were significantly lower than those of group C；compared with group P，serum level of SP at 48 h after surgery as well as serum
levels of PGE2 at 12，24 and 48 h after surgery were significantly decreased in group F，and serum level of IL-6 at 48 h after
surgery，serum levels of SP at 24 and 48 h after surgery，serum levels of PGE2 at 12，24，48 h after surgery were decreased
significantly in group L；compared with group F，serum level of SP at 48 h after surgery as well as serum levels of PGE2 at 12，
24，48 h after surgery were all decreased significantly in group L（P＜0.05）. There was no statistical significance in the incidence
of anausea and vomiting among 4 groups （P＞0.05）. CONCLUSIONS：Parecoxib sodium，flurbiprofen axetil and lornoxicam
combined with PICA can effectively relieve the pain of patients after gynecological laparoscopic surgery and reduce the levels of
serum related factor，and lornoxicam has the most obvious effect.
KEYWORDS Laparoscopic； Gynecology； Patient controlled intravenous analgesia； Non-steroidal anti-inflammatory drugs；
Parecoxib sodium；Flurbiprofen axetil；Lornoxicam；Postoperative analgesis

腹腔镜手术具有创伤小、出血少、恢复快等优点，在 昔康和帕瑞昔布钠为选择性 COX-2 抑制剂 [7-8] 。为比较
[1]
妇科手术中的应用越来越广泛 。与传统手术方式相 帕瑞昔布钠、氟比洛芬酯、氯诺昔康分别联合舒芬太尼
比，妇科腹腔镜手术具有一定优势，但术后仍然会有一 与地佐辛PICA用于妇科腹腔镜手术患者术后的镇痛效
定程度的疼痛。疼痛是患者术后发生相关并发症的高 果及其对血清炎症因子和疼痛因子、PICA 药物用量的
危因素之一，因此有必要在术后给予一定的镇痛药物， 影响，笔者选择了2017年3月－2019年3月在海南医学
减轻患者疼痛，促进其预后。舒芬太尼与地佐辛是目前 院第二附属医院行妇科腹腔镜手术的患者进行了本
临床常用的镇痛药物，临床常通过自控镇痛（PICA）泵给 研究。
药 [2-3] 。单用 1 种镇痛药物往往难以达到满意的镇痛效 1 资料与方法
果，且高剂量镇痛容易导致药物不良反应（ADR）的发 1.1 纳入与排除标准
生 [4-5] ，因此临床往往联合使用多种镇痛药物以减少单药 纳入标准：（1）年龄 18～55 岁；（2）拟行妇科腹腔镜
的 最 大 剂 量 ，降 低 ADR 的 发 生 率 。 非 甾 体 抗 炎 药 手术；（3）凝血功能正常；（4）愿意配合本研究。
（NSAIDs）可通过抑制环氧合酶（COX）的活性、减少前 排除标准：（1）对本研究药物过敏者；（2）合并心、
列腺素（PG）的合成而发挥抗炎、解热、镇痛作用，现已成 肝、脑、肾等严重系统疾病者；（3）精神异常者；（4）有长
[6]
为临床术后镇痛联合给药的重要药物之一 。临床上最 期饮酒及药物成瘾史者；（5）妊娠期、哺乳期妇女等。
常使用的NSAIDs包括帕瑞昔布钠、氟比洛芬酯、氯诺昔 1.2 研究对象
康等，其中氟比洛芬酯为非选择性COX抑制剂，而氯诺 选取 2017 年 3 月－2019 年 3 月在海南医学院第二

·1746 · China Pharmacy 2020 Vol. 31 No. 14 中国药房 2020年第31卷第14期