帕瑞昔布钠超前镇痛对颌面外科手术患者炎性细胞因子和凝血功能的影响  

Effects of preemptive analgesia with parecoxib injection on plasma inflammatory mediators and coagulation function in patients undergoing maxillofacial surgery

作　　者：程磊[1] 李斌[1] 胡惠英[1] 吴坛光[1] 

机构地区：[1]解放军第161医院麻醉科,湖北武汉430010

出　　处：《临床军医杂志》2011年第1期106-108,共3页Clinical Journal of Medical Officers

摘　　要：目的观察帕瑞昔布钠超前镇痛对颌面外科手术患者炎性细胞因子和凝血功能的影响。方法将60例在全麻下行颌面外科手术患者随机分为Ⅰ、Ⅱ两组,每组30例:Ⅰ组于手术开始前30 min静脉注射帕瑞昔布钠40 mg,Ⅱ组静脉注射生理盐水10 ml,术中给予靶控输注丙泊酚和瑞芬太尼静脉全麻,维持其血浆浓度分别为3.5～5.0 mg/L和3.0μg/L。于麻醉诱导前(T1)、术毕(T2)、术后6 h(T3)、术后24 h(T4)测定血浆TNF-α、IL-6、IL-10浓度及出凝血时间,记录术毕即刻、术后6、24 h视觉模拟镇痛评分(visual analogue scale,VAS)。结果术毕及术后6h VAS评分Ⅰ组为(1.8±0.7)分和(2.1±0.8)分,显著低于Ⅱ组(2.9±0.9)分和(3.8±0.8)分(P<0.05);术后24 h VAS评分两组差异无统计学意义(P>0.05);两组T2～4时TNF-α、IL-6、IL-10水平均较T1时明显升高(P<0.05);Ⅰ组与Ⅱ组比较,T2～4时TNF-α、IL-6水平明显降低(P<0.05),IL-10水平明显升高(P<0.05);两组凝血功能比较差异无统计学意义(P>0.05)。结论帕瑞昔布钠超前镇痛效果好,能减轻手术引起的过度炎性反应且不影响凝血功能。Objective To evaluate the effects of preemptive analgesia with parecoxib injection on plasma inflammatory mediators and coagulation function in patients undergoing maxillofacial surgery.Methods Sixty ASA Ⅰor Ⅱ patients undergoing maxillofacial surgery were randomly divided into 2 groups（n=30 each）： Patients inⅠ group receied parecoxib 40mg IV 30min before operation and patients in Ⅱgroup only receied an injection of same amount of saline.Anesthesia was induced with propofol and remifentany by TCI at target plasma concentrations of 3.5～5.0 mg/L and 3.0 μg/L.The venous blood was drawn before the induction of anesthesia（T1）,immediately after the end of operation（T2）,6h and 24h after operation（T3,4）for determination of serum levels TNF-α、IL-6 、IL-10 and coagulation function.Visual analogue scale was measured at immediately after operation、6h and 24h after operation.Results Visual analogue scale was（1.8±0.7）and（2.1±0.8） at the end of operation and 6h after operation in groupⅠ,which was lower than that in group Ⅱ（2.9±0.9）and（3.8±0.8）（P〈0.05）.The concentrations of plasma TNF-α、IL-6、IL-10 were significantly increased from the end of operation to 24h after operation（T2-T4） compared with T1 in all patients（P〈0.05）.The concentrations of plasma TNF-α、IL-6 at T2-T4 in groupⅠ were obviously lower than that in group Ⅱ（P〈0.05）,while the level of IL-10 at T2-T4 in groupⅠ were obviously higher than that in group Ⅱ（P〈0.05）.There were no significant differences in coagulation function in the two groups（P〉0.05）.Conclusion Preemptive analgesia with parecoxib has perfect analgesic effect in patients undergoing maxillofacial surgery and could reduce inflammatory response effectively without affecting coagulation function.

关 键 词：帕瑞昔布钠 超前镇痛 炎症介质 

分 类 号：R971.2[医药卫生—药品]