结果：镇痛效果，用药组与对照组相比，疼痛减轻，清醒后两组比较有显著差异（P<0.05）；术后6h、12h、24h以及48h两组相比均无明显差异。 用药组不良反应少，基本无睡眠障碍，生命征平稳。
结论：塞来昔布用于术后镇痛具有满意的疗效及安全性，适合于腹腔镜手术术后的镇痛治疗。
关键词：塞来昔布；腹腔镜手术；术后镇痛
THE CLINICAL RESEARCH OF EFFICACY OF CELECOXIB IN THE TREATMENT OF POSTOPERATIVE PAIN IN LAPAROSOPIC SURGERY PATIENTS
Zong-bin JIANG, Yong WANG, Xue-zhu YANG ,Rui-lin HE, Zi-jin HUANG, Feng-rui YANG
The Centre of Pain Medicine of Guangxi Medical University，Nanning 530007
ABSTRACT
Objective: To observe the effect and the safety of the Celecoxib as the analgesic in laparoscopic surgery patients.
Methods: 60 cases of laparosopic surgery patients were divided into two groups randomly. Celecoxib was used as the postoperative analgesic in the experiment group and the rest in the control group. The administration of Celecoxib was as follows: 2 capsules were taken at 8～12 hours before surgery by oral, and then 1 capsule was taken at 6 hours after operation when patients could eat food. Celecoxib was administered 1 capsule twice a day(in the morning and evening) at the first and the second postoperative day. VAS score, adverse reaction, the sleep satisfaction of the patients and the vital signs were observed and recorded.
Results: Compared with the control group, the experiment group showed significant difference(P<0.05) in VAS after recovery, and the two groups showed no difference at 6h, 12h, 24h and 48h after operation. They were fewer adverse reaction, better sleep satisfaction and more stable vital signs in the experiment group.
Conclusion: Celecoxib demonstrated a satisfactory effect and safety using in postoperative analgesia in laparoscopic surgery patients.
Key words: celecoxib；laparoscopic surgery；postoperative analgesia
急性疼痛可引致心理、生理问题而影响患者康复。美国疼痛学会和国际医疗机构协作委员会均建议将急性疼痛作为临床检查的第五个生命体征[1,2]。随着人们对生活质量以及医疗质量要求的不断提高，对手术中与手术后无痛的要求越来越高。塞来昔布(西乐葆)是1998年末美国FDA批准上市的第一个COX-2抑制剂，也是全球第一个用于缓解成人骨性关节炎和类风湿关节炎症状的选择性COX-2抑制剂，同时也用于手术后的镇痛[3]。但国内塞来昔布用于一般手术后特别是腹腔镜手术后急性疼痛的疗效及安全性报道尚少，本文就塞来昔布用于腹腔镜患者术后镇痛的疗效及安全性进行临床观察。
材料与方法
1．临床资料
选择2007年3月～2007年7月行腹腔镜手术治疗的非胃肠手术患者60例，全部为男性，年龄18岁～40岁，体重50～70kg，ASAⅠ～Ⅱ；手术种类包括：微创外科精索静脉曲张高位结扎术及疝修补术。随机分为用药组和对照组，每组各30例。（表1） 
2．给药及观察
（1）给药方法
给药时间：用药组患者在给药前须签署知情同意书，之后告知患者服药方法。塞来昔布给药方法为：手术前8～12h口服两粒（200mg/粒），即禁食前首次给药；术后6h患者可进食后再次口服一粒，术后第一天、第二天每天口服两次（早晚各一次），每次一粒。共用三天，总用量为7粒/人。
（2）观察方法：
视觉模拟评分法：视觉模拟评分法（visual analogue scale , VAS ），系采用一条长 10cm的直线，两端分别标上数字0和10，0表示无痛，10表示想象中的最剧烈疼痛。在测量前向病人介绍VAS含义及与疼痛的关系，让病人在VAS表上移动游动标尺，标尺所处的位置代表病人疼痛程度。
药物不良反应：服药期间，每日观察询问和记录患者的不良反应。
睡眠满意度：睡眠满意度（术后当晚睡眠障碍进行分级，10分标准：0＝无睡眠障碍，10＝最大睡眠障碍）
生命征变化：分别于术前8h、清醒后30min、术后6h、术后12h、术后24h、术后48h、术后72h观察和记录患者的生命体征（HR、BP、SpO2）。
3．统计学方法
显著性检验采用两样本均数比较的t检验，P<0．05为差异有显著性。
结 果
1．疼痛VAS评分结果
用药组与对照组相比，疼痛明显减轻，用药组清醒后VAS为0.47±1.06；对照组清醒后VAS为2.67±1.68，两组比较有显著差异（P<0.05）；术后6h、12h、24h以及48h两组相比均无明显差异（P>0.05）。见图
2．药物不良反应
用药组没有发现明显的不良反应，只有 2例（3.33%）患者出现恶心呕吐现象，1例（1.67％）患者出现腹胀；对照组有1例（1.67%）发生恶心呕吐，1例（1.67％）患者出现腹胀。两组比较没有明显的差异。（表2）
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