方法：本研究经我院医学伦理委员会批准、获得患者及家属同意，选取共同性斜视患者，年龄18～50岁，美国麻醉师协会麻醉危险度分级(ASA Classification of Anesthesia Risk)Ⅰ级，拟行斜视矫正术者，采用随机、双盲、对照的研究方法，随机分为4组(n=20)：帕瑞昔布组(P组)、布托啡诺组(B组)、杜冷丁组(D组)、生理盐水组(N组)，分别于术前30min臀大肌肌肉注射，P组注射用帕瑞昔布钠40mg、B组注射用布托啡诺1mg、D组杜冷丁50mg、N组生理盐水2mL。记录术前1d(T₀)基础心率(heart rate，HR)、平均动脉压(meananerial pressure，MAP)； 术中(T₁)记录疼痛数字模拟评分(numeric rating scales，NRS)、眼心反射(culocardiac reflex，OCR)及恶心呕吐、出汗不良反应； 术后2h(T₂)、4h(T₃)、8h(T₄)观察NRS、HR、MAP及恶心、呕吐不良反应。

结果：T₁，P，B，D各组NRS均较N组低，差异有统计学意义(P<0.05)，OCR及恶心呕吐、出汗情况差异无统计学意义(P>0.05)； T₂，恶心呕吐症状D组较P，B，N三组明显，N组较P，B两组明显，差异有统计学意义(P<0.05)，P，B组差异无统计学意义，NRS各组间差异无统计学意义(P>0.05)； T₃，D，N两组NRS均较T₂增大，与P，B两组比较差异有统计学意义(P<0.05)，D组恶心呕吐症状较P，B，N三组明显，差异有统计学意义(P<0.05)，P，B，N组间差异无统计学意义(P>0.05)； T₄，各观察指标差异无统计学意义(P>0.05)。术后P，B组NRS在各时间点差异无统计学意义(P>0.05)。

结论：帕瑞昔布钠单剂量超前镇痛应用于局部麻醉下斜视矫正术，具有良好的术中和术后镇痛效果，可替代精麻类管制镇痛药布托啡诺和杜冷丁，并能减轻术后恶心呕吐症状。

METHODS: This was a prospective, randomized, double-blind, placebo-controlled study.After the ethic committee approval and written conformed consent were obtained, 80 ASA Ⅰ patients aged 18-50 years undergoing strabismus surgery under local anesthesia were randomly allocated to 4 groups(n=20 each): group P received intramuscular parecoxib(40mg), group B received intramuscular butorphanol(1mg), group D received intramuscular pethidine(50mg), and group N received intramuscular normal saline(2mL). All patients received the drug at 30 minutes before surgery. Basal heart rate(HR)and meananerial pressure(HAP)were recorded on the day before surgery. The intensity of pain was measured using(numeric rating scales)NRS(0-10, 0=no pain, 10=worst pain)and recorded during operation time(T₁). Meanwhile, culocardiacreflex(OCR), nausea and vomiting, and sweating were also recorded. NRS, nausea and vomiting were recorded at 2 hours(T₂), 4 hours(T₃), 8 hours(T₄)after operation.

RESULTS: The NRS scores at T₁ were significantly lower in groups P, B, and D than in group N. OCR, nausea and vomiting, and sweating at T₁ were not significantly different among the 4 groups. The nausea and vomiting were significantly higher in group D than in groups P, B, and N. The NRS scores at T₂ were not significantly different among the 4 groups. The NRS scores in groups D and N at T₃ were significantly higher than those at T₂. And the NRS scores at T₃ were significantly higher in group D and N than groups P and B. The nausea and vomiting were significantly higher in group D than in groups P, B, and N. The NRS, nausea and vomiting were not significantly different among the 4 groups. The NRS scores in groups P and B were not significantly different at T₂, T₃, and T₄.

CONCLUSION:Preemptive analgesia with 40mg of parecoxib for strabismus surgery under local anesthesia is effective intraoperatively and postoperatively, and can reduce the postoperative nausea and vomiting.