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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 2 mL。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24 h 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。

英文摘要:

Objective:To investigate the analgesic effect of preoperative and postoperative injection of celecoxib on patients with meningioma.Methods:120 cases of patients with meningioma in our hospital were randomly divided into the preoperative group, postoperative group and control group, with 40 cases in each group. All patients were fasted and given conventional diet before operation, the patients in preoperative group were treated by intravenous injection of parecoxib sodium 40mg 15min before anesthesia, all patients underwent anesthesia induction (atropine + sufentanil + Mi of midazolam + propofol) intravenous injection, anesthesia was maintained with propofol and remifentanil intravenous infusion, meningioma resection and postoperative in accordance with the specific circumstances of discontinuation of propofol, remifentanil, group, postoperative patients in the operating end 15min before intravenous injection of parecoxib sodium 40 mg, and control group patients in the operation end before the injection of normal saline 2ml. The pain visual analogue scale (VAS), simple intelligence state scale (MMSE) score, serum cortisol (cortisol) level and incidence of adverse reaction of three groups were observed and compared.Results:Compared with the control group, the VAS scores were lower in preoperative group and postoperative group (P<0.05); compared with the postoperative group, the VAS score at 1h after operative level was lower in the preoperative group (P<0.05). The MMSE scores of the three groups were decreased after operation(P<0.05),compared with the control group, the MMSE levels of preoperative group and postoperative group at 1 h, 24 h after operative were higher (P<0.05); compared with the control group, the cortisol level 1h, 24h after operative was low of the preoperative group and postoperative group, the difference was statistically significant (P<0.05); compared with the postoperative group, the cortisol level was lower in preoperative group, the difference was statistically significant (P<0.05); the side effects of the 3 groups of patients the incidence rate showed no significant difference (P>0.05).Conclusion:Analgesic effect of pre-operative injection of parecoxib sodium was better, and the cognitive function recovered quickly after operation.

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