帕瑞昔布钠术前用药对胃肠道肿瘤术后镇痛效果和细胞因子的影响  

Preemptive analgesic effects of parecoxib on postoperative analgesic efficacy and serum cytokine response in patients undergoing gastrointestinal tumor resection

作　　者：刘佩蓉[1] 刁枢[1] 师小伟[1] 曹晓琼[1] 

机构地区：[1]上海市第七人民医院麻醉科,200137

出　　处：《临床麻醉学杂志》2013年第7期669-671,共3页Journal of Clinical Anesthesiology

基　　金：上海市浦东新区卫生局青年基金(PW2010B-10)

摘　　要：目的观察帕瑞昔布钠术前用药对胃肠道肿瘤术后芬太尼PCA镇痛的效果和细胞因子变化的影响。方法择期行胃肠道肿瘤根治术患者60例,随机均分为两组:帕瑞昔布钠联合芬太尼组(P组)和单纯芬太尼组(F组)。术前30minP组静注帕瑞昔布钠40mg(用生理盐水稀释至2ml),F组静注生理盐水2ml,首剂后12h重复用药一次,术毕两组均采用芬太尼20μg/kgPCA镇痛。评价术后2、6、12和24h的静息和翻身时VAS评分。记录术后12和24hPCA按压总次数和有效次数,术后12和24h芬太尼用量。记录术前、术毕、术后6和24h血浆白细胞介素(IL)-6、IL-10和肿瘤坏死因子α(TNF)-α的变化。记录恶心呕吐、头晕、嗜睡、腹胀等不良反应的发生情况。结果 P组术后2、6h静息时和术后2、6、12和24h翻身时的VAS评分明显低于F组(P<0.05);P组术后12和24hPCA按压总次数、有效次数和芬太尼用量明显少于F组(P<0.05);P组术毕、术后6和24h血浆IL-6浓度明显低于F组,血浆IL-10浓度明显高于F组,术毕时血浆TNF-α浓度明显低于F组(P<0.05)。两组恶心呕吐、头晕、嗜睡、腹胀等不良反应的差异无统计学意义。结论帕瑞昔布钠术前用药能减少胃肠道肿瘤术后芬太尼PCA用量,提高术后镇痛效果,同时减低IL-6的浓度和增加IL-10的浓度。Objective To observe the preemptive analgesic effects of pareeoxib on postoperative analgesic efficacy and serum cytokine in patients after gastrointestinal tumor surgery. Methods Sixty ASA Ⅰ or Ⅲ patients undergoing gastrointestinal tumor surgery were randomly allocated into 2 groups （n=30 each） .. Pareeoxib sodium combined with fentanyl group （group P）, and fentanyl group （group F）. At 30 minutes before skin incision and 12 hours after surgery, group P received intravenous infusion of 40 mg parecoxib sodium separately, Group F received intravenous infusion normal saline 2 ml at these time points. Patients received an patient controlled analgesia （PCA） regimen of Fentanyl after surgery. VAS score were recorded at 2, 6, 12 and 24 hours after surgery. Total fentanyl consumption was recorded at 12 and 24 h after surgery. The concentration of serum interleukin-6（IL-6）, interleukin-10 （IL-10）, and tumor necrosis factor-alpha （TNF-a） were assessed before surgery, at the end of surgery, 6 h after surgery, 24 h after surgery. Adverse effects were also recorded. Results VAS scores at 2,6,12 and 24 h after operation were lower in group P（P〈0. 05） compared with group F. The fentanyl consumption recorded at 12 and 24 h after surgery was lower in group P（P〈0. 05）. The concentration of serum IL-6 was lower in group P, but serum IL-10 was higer in group P versus group F（P〈0. 05）. There were no serious adverse effects in both groups. Conclusion Parecoxib sodium combined with fentanyl after gastrointestinal tumor surgery can provide better postoperative analgesia, reduce the fentanyl consumption, attenuated IL-6 production and increase IL-10 production.

关 键 词：帕瑞昔布钠 芬太尼 术后镇痛 胃肠道肿瘤 细胞因子 

分 类 号：R614[医药卫生—麻醉学]