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目的:比较手术前后注射帕瑞昔布钠对脑膜瘤切除术后的镇痛效果。方法:收集我院收治的120例行脑膜瘤切除术患者,随机分为术前组、术后组以及对照组,每组40例。术前组在麻醉前15 min静注帕瑞昔布钠40 mg所有患者行麻醉诱导(咪达唑仑+异丙酚+罗库溴铵+舒芬太尼)静脉注射,维持麻醉采用异丙酚+瑞芬太尼静脉泵注,行脑膜瘤切除术术毕根据患者具体情况停用异丙酚、瑞芬太尼术后组患者在手术结束前15 min静注帕瑞昔布钠40 mg,对照组患者在手术结束前15 min静注生理盐水2mL。观察并比较三组患者各时间点的疼痛视觉模拟评分(VAS)、简易智能状态量表(MMSE)评分、血清皮质醇(cortisol)水平以及患者不良反应发生率。结果:与对照组相比术前组、术后组患者术后1 h的VAS评分水平较低差异具有统计学意义(P<0.05);与术后组相比术前组患者的术后1 h的VAS评分水平较低差异具有统计学意义(P<0.05);术后三组患者的MMSE评分与术前相比均下降(P<0.05),与对照组相比术前组患者的术后1 h、术后24h MMSE评分较高差异具有统计学意义(P<0.05);与对照组相比术前组、术后组患者术后1 h以及术后24 h的皮质醇水平较低差异具有统计学意义(P<0.05);与术后组相比术前组患者的皮质醇水平较低差异具有统计学意义(P<0.05);三组患者的副作用发生率相比无明显差异(P>0.05)。结论:术前注射帕瑞昔布钠的镇痛效果较术后注射更好术后认知功能恢复较快。
Objective: To compare the analgesic efficacy of parecoxib sodium injection before and after surgery for meningeal tumor resection. Methods: Totally 120 cases of meningioma resected in our hospital were collected and randomly divided into preoperative group, postoperative group and control group, 40 cases in each group. Preoperative anesthesia 15 min intravenous injection of parecoxib 40 mg all patients underwent anesthesia induction (midazolam + propofol + rocuronium + sufentanil) intravenous injection of anesthesia with isopropyl Phenol + remifentanil intravenous injection, meningioma surgery completed according to the specific circumstances of patients with discontinuation of propofol, remifentanil group patients before the end of 15 min intravenous parecoxib sodium 40 mg , Control group patients intravenous infusion of 2mL 15 min before the end of surgery. The pain visual analogue scale (VAS), MMSE score, cortisol level and incidence of adverse reactions in each group were observed and compared. Results: Compared with the control group, the VAS score of the preoperative group and the postoperative group at 1 hour after operation was significantly lower than that of the control group (P <0.05). Compared with the postoperative group, the postoperative 1 h (P <0.05). The MMSE scores of three groups after operation were significantly lower than those before operation (P <0.05). Compared with the control group, the patients with preoperative There was a significant difference in MMSE score at 1 h after operation and at postoperative 24h (P <0.05). Compared with the control group, the cortisol levels at 1 h and 24 h after operation in the preoperative and postoperative groups were lower (P <0.05). Compared with the postoperative group, there was a statistically significant difference in the lower cortisol level in the preoperative group (P <0.05). There was no significant difference in the incidence of side effects between the three groups (P> 0.05). Conclusion: Preoperative injection of parecoxib sodium has better analgesic effect than postoperative injection, and cognitive function recovered quickly.