经蝶入路神经外科术前给予帕瑞昔布联合术后局部神经阻滞对镇痛和应激反应的影响

Preoperative parecoxib administration and postoperative nerve block in transsphenoidal neurosurgery for analgesia and stress reaction

目的探讨帕瑞昔布联合局部神经阻滞对择期神经外科全麻颅脑手术患者术后镇痛的临床效果及其对机体应激反应的影响。方法选择择期行开颅手术患者120例,入选病例采用2×2析因设计随机分为四组:A组(术前不给予帕瑞昔布及术后不行局部神经阻滞)、B组(术前给予帕瑞昔布)、C组(术后行局部神经阻滞)、D组(术前给予帕瑞昔布及术后行局部神经阻滞)。记录各时间段患者的疼痛模拟评分(VAS)及测定血浆内皮素1(ET-1)、白介素6(IL-6)、皮质醇(Cor)水平。结果术后1 h,A组VAS评分较其他三组高(P<0.05),术后12 h内,B、C、D组明显低于A组(P<0.01),D组略低于B、C两组,三组间差异不显著。各组患者术后ET-1、IL-6及Cor水平较术前水平均显著升高(P<0.05),ET-1和Cor水平在术后6 h达高峰,而IL-6持续增高,24 h缓慢降低,给予帕瑞昔布麻醉的患者各指标均显著降低(P<0.05),效果好于单纯的术后局部神经阻滞,联合应用与其比较,效果较好,但差异无显著性意义。结论帕瑞昔布能明显缓解围术期的过度应激反应,联合局部神经阻滞可有效减轻神经外科术后疼痛且持续时间更长,有更好的安全性。

Objective To observe and evaluate postoperative pain of patients undergoing transsphenoidal neurosurgery,and to explore the clinical effect of parecoxib combined with local nerve block on postoperative anesthesia and stress response in patients who were candidates for craniotomy surgery under general anesthesia.Methods One hundred and twenty patients undergoing craniotomy surgery were included in this study,and were randomly divided into four groups using 2 × 2 factorial design：group A（no preoperative parecoxib or postoperative nerve block）,groupB （preoperative parecoxib administration）,group C （postoperative local nerve block）,group D （preoperative parecoxib administration and postoperative local nerve block）.The patients were assessed with visual analogue scale after operation.Plasma endothelin-l,interleukin-6 and cortisol levels were determined.Results At postoperative 1 hours,scores of visual analogue scale in group A were higher than those in other three groups（P ＜ 0.05） ;at 12 hours,visual analogue scale scores in groups B,C,D were significantly lower than that in group A（P ＜0.01）,and that scores in group D was slightly lower than that of groups B and C,there was no significant difference between the three groups.The plasma endothelin-1,interleukin-6 and cortisol levels in each group were significantly increased compared with before surgery（P ＜ 0.05）,endothelin-1 and cortisol levels were reached the peak at 6 hours,while interleukin-6 level was gradually increased and began to decrease at 24 hours.Parecoxib administration for anesthesia was significantly reduced the above index levels （P ＜ 0.05）,which was superior to local nerve block,and the combination of preoperative parecoxib administration and postoperative local nerve block exhibited better effects,with no significant difference.Conclusions Parecoxib could obviously alleviate excessive stress in the peri-operative period,and its combination with local nerve block effectively relieves postoperative pain and lasts for a longer period,with a better safety.