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目的:观察帕瑞昔布钠用于大骨节病（Kashin-Beck disease，KBD）患者全膝关节置换术术后镇痛效果。方法:采用前瞻性设计，选取2017年1月至2019年1月于烟台山医院和火箭军总医院行全膝关节置换术的严重膝关节KBD患者84例作为研究对象。采用随机数字表法将患者分为对照组（42例）和观察组（42例），对照组术前不予以任何镇痛处理，观察组予以帕瑞昔布钠超前镇痛，在麻醉诱导前30 min静脉注射40 mg帕瑞昔布钠，比较两组患者术后30 min、2 h、4 h及12 h视觉模拟评分（visual analogue score，VAS）、按压患者自控式静脉镇痛泵（PCIA）次数，术前及术后12、24 h两组患者膝关节美国纽约特种外科医院（Hospital for Special Surgery，HSS）评分、应激反应指标[去甲肾上腺素（norepinephrine，NE）、血糖（blood glucose，BG）和皮质醇（cortisol，Cor）]水平，同时比较两组患者药物不良反应的发生情况。结果:两组VAS评分呈先升高后降低的趋势，术后30 min两组VAS评分比较差异无统计学意义（n P > 0.05），术后2、4、12 h观察组VAS评分[（5.75 ± 0.27）、（4.02 ± 0.85）、（2.04 ± 0.23）分]均显著低于对照组[（7.34 ± 0.35）、（5.96 ± 0.90）、（3.89 ± 0.27）分， n P均< 0.05]。两组HSS评分随时间逐渐升高，术前两组HSS评分比较差异无统计学意义，术后12和24 h观察组HSS评分[（53.19 ± 6.53）、（75.18 ± 4.63）分]显著高于对照组[（46.29 ± 6.37）、（60.38 ± 5.29）分，n P均< 0.05]。两组应激反应指标水平随时间而上升，且术后12、24 h观察组血浆NE[（325.94 ± 25.67）、（397.63 ± 27.55）ng/L、BG（5.38 ± 0.52）、（5.41 ± 0.54）nmol/L]及Cor[（241.94 ± 14.18）、（253.82 ± 14.65）mg/L]水平均显著低于对照组[（387.28 ± 26.92）、（437.84 ± 28.96）ng/L，（5.79 ± 0.43）、（6.54 ± 0.52）nmol/L，（275.39 ± 13.72）、（289.63 ± 13.95）mg/L，n P均< 0.05]。两组术后24 h按压PCIA次数均显著高于术后12 h，且观察组术后12和24 h按压PCIA次数（4.62 ± 0.84、8.38 ± 0.41）显著低于对照组（8.26 ± 0.65、12.48 ± 0.73，n P均< 0.05）。观察组不良反应发生率（19.05%，8/42）显著低于对照组（52.38%，22/42，n P 0.05). But 2, 4 and 12 h after operation, the VAS score in the observation group [(5.75 ± 0.27), (4.02 ± 0.85), (2.04 ± 0.23) points] were significantly lower than those in the control group [(7.34 ± 0.35), (5.96 ± 0.90), (3.89 ± 0.27) points, n P 0.05). And 12 and 24 h after operation, the HSS scores in the observation group [(53.19 ± 6.53), (75.18 ± 4.63) points] were significantly higher than those in the control group [(46.29 ± 6.37), (60.38 ± 5.29) points, n P < 0.05]. The level of stress response index of the two groups increased with time. And 12 and 24 h after operation, the levels of NE [(325.94 ± 25.67), (397.63 ± 27.55) ng/L], BG [(5.38 ± 0.52), (5.41 ± 0.54) nmol/L] and Cor [(241.94 ± 14.18), (253.82 ± 14.65) mg/L] in the observation group were significantly lower than those in the control group [(387.28 ± 26.92), (437.84 ± 28.96) ng/L, (5.79 ± 0.43), (6.54 ± 0.52) nmol/L, (275.39 ± 13.72), (289.63 ± 13.95) mg/L, n P < 0.05]. The number of PCIA pressing 24 h after operation in both groups was significantly higher than that 12 h after operation. The number of PCIA (4.62 ± 0.84, 8.38 ± 0.41) in the observation group was significantly lower than that in the control group (8.26 ± 0.65, 12.48 ± 0.73) 12 and 24 h after operation ( n P < 0.05). The incidence of adverse reactions (19.05%, 8/42) in the observation group was significantly lower than that in the control group (52.38%, 22/42, n P < 0.05).n Conclusions:Preprcelecoxib can significantly reduce postoperative pain, reduce the expression of stress index, improve knee motion in a short period of time, reduce the number of pressing (PCIA) and the incidence of adverse drug reactions in patients with severe KBD of knee joint.