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目的探讨帕瑞昔布钠不同时间给药对大脑半球神经胶质瘤切除患者术后的镇痛效果及对β-内啡肽水平的影响。方法选择2010年1月至2013年12月神经外科行大脑半球神经胶质瘤切除术的96例患者为研究对象。将96例患者按照随机数字表法随机分为A组、B组、C组3组各32例。A组:麻醉诱导前10 min静脉注射帕瑞昔布钠40 mg。B组:在术毕时静脉注射帕瑞昔布钠40 mg。C组:不给予镇痛药物。统计受试者视堂模拟评分(VAS)、Ramsay评分、β-内啡肽水平、术后不良反应发生情况及满意度。结果 A组、B组VAS评分均低于同时间点C组(P均<0.05),且A组术后12 h、24 h VAS评分低于同时间点B组,差异有统计学意义(P均<0.05);3组不同时间点Ramsay评分差异无统计学意义(P均>0.05);A组术前、术毕、术后不同时间血清β-内啡肽水平无显著波动,B组、C组术毕、术后血清β-内啡肽水平均较术前升高,且均高于同期A组,差异有统计学意义(P均<0.05);3组术后均未出现严重不良反应,3组术后并发症发生率差异无统计学意义(P>0.05);3组患者术后24 h满意度差异有统计学意义(P<0.05)。结论大脑半球神经胶质瘤切除术中术前给予帕瑞昔布钠可以提高术后镇痛效果,且不良反应轻微,同时还可抑制机体血β-内啡肽的表达,减轻应激反应。
Objective To investigate the analgesic effects of parecoxib sodium administered at different times on postoperative hemipurgo glioma resection and its effect on β-endorphin levels. Methods Ninety-six patients with neuroblastoma in the hemisphere from January 2010 to December 2013 were enrolled in this study. The 96 patients were randomly divided into A group, B group, C group, three groups of 32 cases. Group A: intravenous injection of parecoxib 40 mg 10 min before induction of anesthesia. Group B: Parecoxib 40 mg was intravenously injected at the time of surgery. Group C: No analgesics. Statistical test subjects visual analogue scale (VAS), Ramsay score, β-endorphin levels, postoperative adverse reactions and satisfaction. Results The VAS scores of group A and group B were lower than those of group C at the same time point (all P <0.05), and the VAS scores of group A at 12 and 24 h after operation were lower than those at group B at the same time point (P (All P <0.05). There was no significant difference in Ramsay scores at 3 time points (P> 0.05). There was no significant fluctuation of serum β-endorphin levels in group A before operation, The serum levels of β-endorphin in group C after operation were significantly higher than those in group A, and both were significantly higher than those in group A at the same period (all P <0.05). No serious adverse reactions occurred in the three groups There was no significant difference in the incidence of postoperative complications between the three groups (P> 0.05). There was a significant difference in satisfaction between the three groups at 24 hours (P <0.05). Conclusion Preoperative administration of parecoxib sodium in the treatment of gliomas in the hemisphere can improve the postoperative analgesic effect with mild side effects. It can also inhibit the expression of β-endorphin and reduce the stress response.