帕瑞昔布钠应用于颅脑手术患者术后镇痛的效果及其对应激反应的影响

Study on analgesic effect and stress reaction of parecoxib sodium in postoperative craniocerebral operation

目的评价颅脑外科手术术后应用帕瑞昔布钠的镇痛效果及安全性,并探讨其对术后应激反应的影响。方法选择行颅脑手术的112例患者,随机分为2组,每组56例。Ⅰ组患者在硬膜关闭时予以静脉滴注10 mL生理盐水,Ⅱ组患者在硬膜关闭时予以静脉滴注40 mg(10 mL)帕瑞昔布钠,对2组患者给予生理盐水或帕瑞者布钠前(T0)、术后1、2、6、12、24 h的心率(HR)、呼吸频率(RR)、平均动脉压(MAP)、血氧饱和度(SpO2)及术后1、2、6、12、24 h的疼痛VAS评分进行比较。检测2组患者麻醉前、术后1、6、12 h白细胞介素-6(IL-6)、血浆内皮素及皮质醇水平,并观察患者恶心呕吐的发生率。结果Ⅰ组患者术后1、2、6 h的HR及MAP均显著高于T0(P<0.05);Ⅱ组患者术后1、2、6 h的HR显著高于T0(P<0.05)。Ⅱ组患者术后1、2、6 h的HR及MAP均显著低于Ⅰ组(P<0.05)。Ⅱ组患者术后1、2、6、12及24 h疼痛VAS评分显著低于Ⅰ组(P<0.05)。2组患者术后1、6、12 h的IL-6、血浆内皮素及皮质醇水平显著高于麻醉前(P<0.05),且Ⅱ组患者术后1、6、12 h的IL-6、血浆内皮素及皮质醇水平显著低于Ⅰ组(P<0.05)。2组患者恶心呕吐的发生率比较差异无统计学意义(P>0.05)。结论帕瑞昔布钠用于颅脑手术的术后镇痛中,镇痛效果明显,安全性好,且能显著改善患者术后的应激反应。

Objective To evaluate the analgesic effect, safty and stress reaction of parecoxib sodium in postoperative craniocerebral operation. Methods One hundred and twelve patients who received craniocerebral operation were divided into two groups randomly with 56 patients in each group. Patients in group I were given intravenous infusion of 10 mL physiological saline when the epidural was closed. Meanwhile,patients in group I1 were given intravenous infusion of 40 mg（ 10 mL） pare- coxib sodium. The heart rate （ HR）, respiratory rate （ RR）, mean arterial pressure （MAP） and saturation of blood oxygen （SpO2 ） before giving saline or parecoxib sodium （ TO ） and at 1,2,6,12,24 h after operation were monitored in the two groups. The visual analogue scales（VAS） scores of 1,2,6,12,24 h after operation were compared between the two groups. The levels of interleukin（IL）-6 ,plasma endothelin and cortisol ,the incidence of nausea and vomiting were compared before anes- thesia and at 1,6,12 h after operation between the two groups. Results HR and MAP levels of 1,2 and 6 h after operation were significantly higher than those at TO in group I （ P 〈 0.05 ）, HR level of 1,2 and 6 h after operation was significantly higher than that at To in group II （P 〈0.05）. HR and MAP levels of 1,2 and 6 h after operation in group H were lower than those in group I （P 〈 0.05 ）. The VAS score of 1,2,6,12 and 24 h in group I1 was lower than that in group I （P 〈 0.05）. The IL-6 ,plasma endothelin,cortisol levels of 1,6 and 12 h after operation in the two groups were higher than those before an- esthesia（P 〈0. 05） ,and the levels of them in group II were significantly lower than those in group I （P 〈0.05）. There was no significant difference in the incidence of nausea and vomiting between the two groups （ P 〉 0.05 ）. Conclusion Analgesic effect and safety of parecoxib sodiUmin in postoperative craniocerebral operation is good, and it can significantly improve the stress reaction of patients after operation.