经颞路及经鼻蝶窦入路开颅手术患者给予帕瑞昔布的镇痛效果及焦虑缓解  

The effect of Parecoxib for postoperative analgesia and anxiety on patients with trans-temporal and trans-sphenoid craniotomy

作　　者：曲新国[1] 罗俊杰[1] 田学成[1] 吕伟[1] 吴丹艳[2] 

机构地区：[1]湖北医药学院附属人民医院,十堰442000 [2]湖北省十堰市妇幼保健院

出　　处：《国际精神病学杂志》2017年第1期125-127,142,共4页Journal Of International Psychiatry

摘　　要：目的探讨帕瑞昔布(PS)对经颞、鼻蝶窦入路开颅手术患者术后镇痛效果及焦虑情绪的影响。方法将择期行经颞、鼻蝶窦入路开颅手术患者90例,随机分为A组、B组及C组,各30例。A组术前20min予以40mg PS静注,B组术毕予以40mg PS静注,C组术毕予以10mL生理盐水静注。比较三组术前(T_0)、术后2h(T_1)、6h(T_2)、12h(T_3)、24h(T_4)及48h(T_5)各时间点的疼痛评分(VAS)、焦虑评分(SAS)、血浆皮质醇(Cor)含量及血清β-内啡肽(β-EP)及术后不良反应。结果 T_1~T_4各时间点,A组及B组的VAS评分、SAS评分、β-EP及Cor浓度均显著低于C组(P<0.05),且A组显著低于B组(P<0.05);T_5时A组的β-EP及Cor浓度显著低于B组及C组(P<0.05);术后48h内,A组、B组的颅痛定使用率及焦虑、躁动发生率均显著低于C组(P<0.05)。结论 PS对经颞、鼻蝶窦入路开颅手术患者具有镇痛及抗焦虑作用,能够降低应激反应,且术前给药效果更好。Objective To investigate the postoperative analgesic effect and anxiety influence of Parecoxib （PS） for patients with trans-temporal and trans-sphenoid craniotomy. Methods 90 patients undergoing elective craniotomy （ trans-temporal and trans-phenoid ） were enrolled, randomly divided into group A, group B and group C, 30 cases in each. 40mg PS was given intravenously at 20 minutes before operation in group A, 40mg PS was given intravenously before closure of dura mater in group B, 10mL saline was given intravenously before closure of dura mater in group C. The pain scores （ VAS ）, anxiety scores （SAS）, plasma cortisol （Cor）, serum - endorphin （ β -EP） and postopera- tive adverse reactions in three groups were monitored and compared at before operation （T0） and 2h （T1）, 6h （T2）, 12h （ T3 ）, 24h （ T4 ）, 48h （ T5 ） after operation. Results At each time point of T1 - T4, the VAS, SAS scores, β -EP and Cor in group A and B were significantly lower than those in group C （P〈0.05）, and group A were significantly lower than those in group B （P 〈 0.05 ）; The β -EP and Cor at T5 in group A were significantly lower than those in group B and C （P〈0.05）; Within 48h after operation, the utilization of Rotundine and incidence of anxiety, restlessness in group A and B was significantly lower than that in group C （P 〈 0.05 ） . Conclusion PS has nalgesic and anxiolytic ef- fect on patients after trans-temporal and trans-sphenoid craniotomy, can reduce the stress reaction, and it shows bet- ter result if administrated before operation.

关 键 词：开颅手术 帕瑞昔布 术后镇痛 焦虑 应激反应 

分 类 号：R749.05[医药卫生—神经病学与精神病学]