Clinical Study Of Parecoxib Sodium In Preventing Postoperative Shivering In Patients With Moderate Or Higher Burns

Objective:Postoperative chills are a common complication after anesthesia,which refers to the involuntary contraction of muscles during recovery from anesthesia.The incidence of postoperative chills in general anesthesia patients is 5%-60%.The chill is a physiological reaction that can guarantee the normal physiological functions of the body,but may also cause serious adverse reactions.Postoperative chills involve the body's endocrine system,nervous system,and motor system.The specific mechanism is not yet clear.Burns are common clinical traumatic diseases,which can cause severe hypoperfusion of organ tissues,causing coagulation dysfunction and ischemia and hypoxia in patients.Parecoxib is the first COX-2 inhibitor to work through the parenteral route,which has similar analgesic effects to traditional non-steroidal anti-inflammatory drugs.Parecoxib can be quickly hydrolyzed into vardecoxib in the body,that is,the rate-limiting enzyme that converts arachidonic acid into prostaglandin pain mediators,thereby reducing or even eliminating the allergic reaction of nerve endings and producing anti-inflammatory and analgesic effects In addition,the inhibitory effect on COX-1 is not obvious,does not affect the normal function of gastric mucosa,platelets and kidneys,and reduces the incidence of adverse reactions.Parecoxib can inhibit the production of central and peripheral PGE2 and COX,reduce the release of both in the hypothalamus,and make the temperature setting point down,thereby suppressing the response of the temperature regulating center to hypothermia and reducing the incidence of chills.Burn patients are more prone to postoperative chills,and the mechanism is still unclear,which may be related to excessive perioperative body temperature loss and inflammatory reactions caused by burns leading to excessive secretion of PGE2 in the central nervous system.To evaluate the effect of preventive administration of parecoxib sodium on postoperative chills in patients with moderate or higher burns,and to provide a basis for preventing postoperative chills during perioperative period.Methods: The study was approved by the Ethics Committee of Yijishan Hospital of Wannan Medical College,and all patients signed informed consent.Based on pre-experiment,domestic similar research and 15% loss of follow-up rate,60 patients with escharectomy and skin grafting under general anesthesia were selected in Yijishan Hospital of Wannan Medical College and random number table method is used to divide into two groups,30 people in each group.Thirty patients in group P were given parecoxib 40 mg at the time of induction;30 patients in group S were given the same amount of physiological saline at the time of induction.Patients were sent to PACU after the operation and given active thermal insulation measures.Extubation time,vital signs at extubation,RASS score at15 minutes after extubation,and VAS score at 1 hour after operation were recorded,and the patients were observed for chills and duration of chills and Nausea,vomiting,itching and other adverse reactions.SPSS 21.0 statistical software was used to analyze and sort the data.Counting data was described by the number of cases and percentage(%).Differences between statistically inferred groups were tested by ?2;measurement data were described by mean ± standard deviation(x ± s),consistent The comparison between groups of normal distribution measurement data was analyzed by t test;the measurement data that did not meet the normal distribution analysis were analyzed by non-parametric rank sum test.The difference was statistically significant at P <0.05.Results: 1.There was no significant difference in general data(age,gender)between group P and group S(P> 0.05),that is,the baseline data of the two groups were consistent and comparable.2.There was no significant difference in the incidence of postoperative adverse reactions and general perioperative conditions between group P and group S(P> 0.05).3.There was no significant difference in the 1-hour VAS score between the group P and the group S(P> 0.05);there was no significant difference in the RASS score of 15 minutes after extubation between the group P and group S(P> 0.05).4.There was a statistically significant difference in the duration of chills after extubation between the group P and group S(P <0.05);a significant difference in the incidence of chills between the group P and group S(P <0.05)And the probability of chills in group S was significantly higher than that in group P.Conclusion: The administration of 40 mg parecoxib sodium during general anesthesia induction can effectively reduce the incidence of postoperative chills in patients with moderate or higher burns,and can shorten the duration of chills and improve the quality of patients' awake.