帕瑞昔布钠用于颅脑手术患者的镇痛效果及对血浆β-内啡肽的影响

Effects of the parecoxib on postoperative pain and serum level of β-EP in craniotomy

目的观察帕瑞昔布钠不同时点用于颅脑手术患者的镇痛效果及对血浆β-内啡肽的影响。方法择期行神经外科肿瘤手术患者90例,ASAⅠ或Ⅱ级。随机均分为三组,A组麻醉前10min缓慢静注帕瑞昔布钠40mg;B组术毕时缓慢静注帕瑞昔布钠40mg;C组未施行镇痛。三组术后均未行自控镇痛。分别于术后2、6、12、24h记录镇痛评分(VAS评分)和镇静评分(Ramsay评分),记录24h满意度和不良反应;于术前、术毕、术后6、12、24h抽取外周静脉血,采用放射免疫分析法测定患者血浆β-内啡肽和胃泌素浓度。结果 A、B组术后各时点VAS评分明显低于C组(P<0.05),A组术后12、24h时明显低于B组(P<0.05),A组24h满意度最高。B、C组术毕后各时点血浆β-内啡肽浓度明显高于A组(P<0.05);B、C两组差异无统计学意义。三组各时点胃泌素组间差异无统计学意义。结论帕瑞昔布钠可安全有效地应用于颅脑手术的术后镇痛,术前使用可有效减少术后患者血浆β-内啡肽的生成,抑制应激反应。

Objective To study the effects of parecoxib used at different time point on postoperative pain and the level of serum β-EP in eraniotomy. Methods Ninety ASA I or II patients undergoing selective craniotomy were randomly assigned to three groups （n =30） ：group A received parecoxib 40 mg 30 min before incision, group B received parecoxib 40 mg at the end of operation, group C did not receive analgesia. No patient received postoperative patient controlled analgesia （PCA）. Serum β-EP and gastrin were detected at baseline, at the end of the surgery, 6h, 12 h and 24 h after surgery. Visual analog score, Ramsay sedative score, 24 h patient satisfaction and adverse effects were also recorded. Results The analgesic effects of group A and group B at different time points were better than those of group C （P 〈 0. 05）. The score of VAS were significantly lower than that of group B 12 h and 24 h postoperatively. The levels of serum β-EP were significantly higher in group B and group C after operation compared with group A. There was no significant difference in the level of gastrin among three groups. Conclusion Pareeoxib can safely improve postoperative analgesia in patients undergoing craniotomy. It is related to decreased level of serum β- EP and inhibit stress.