帕瑞昔布钠超前镇痛对老年开胸手术患者围术期炎性细胞因子的影响  

Effects of Parecoxib Preemptive Analgesia on Inflammatory Factors in old Patients Undergoing Thoracotomy

作　　者：李清[1] 王宇[1] 罗向红[1] 秦成名[1] 王贤裕[1] 

机构地区：[1]湖北医药学院附属太和医院麻醉科,湖北十堰442000

出　　处：《湖北医药学院学报》2014年第2期141-145,共5页Journal of Hubei University of Medicine

基　　金：湖北省教育厅科学研究计划项目(B20102107);十堰市科学技术研究与开发项目(2010-037S)

摘　　要：目的：观察帕瑞昔布钠超前镇痛对老年开胸手术患者围术期炎性细胞因子的影响。方法：将30例择期全麻下行肺癌和食管癌根治术的老年患者随机分为帕瑞昔布钠组和对照组,各15例。两组患者分别于麻醉诱导前（T1）、术后2 h（T2）、术后6 h（T3）、12 h（T4）取静脉血测定血清白细胞介素-6（IL-6）及肿瘤坏死因子-α（TNF-α）、IL-10浓度。于T1到T4点记录视觉模拟评分（VAS）,观察两组各点MAP、HR、SpO2变化及术后呼吸和循环系统并发症：肺不张、肺部感染、严重心律失常、高血压、心肌梗死等的发生。结果：两组炎性细胞因子TNF-α、IL-6和IL-10浓度T2-T4时点均高于T1。与对照组相比,帕瑞昔布钠组T2-T4时点TNF-α、IL-6浓度均较低（P〈0.05）,IL-10浓度较高（P〈0.05）;帕瑞昔布钠组术后T2-T4时点VAS评分明显低于对照组（P〈0.05）;对照组T2-T4各点MAP、HR、PaCO2较T1及帕瑞昔布钠组显著升高（P〈0.05）;帕瑞昔布钠组患者术后呼吸系统并发症如：肺不张、肺部感染等明显减少（P〈0.05）。结论：帕瑞昔布钠用于老年开胸手术有明显镇痛作用,同时可调节免疫平衡,减轻围术期炎性反应,且术后肺不张、肺部感染等呼吸系统并发症明显减少。Objective To investigate the effects of parecoxib preemptive analgesia on inflammatory factors in old patients undergoing thoraeotomy. Methods Thirty patients underwent lung cancer and esophageal cancer surgery under general anesthesia were randomly divided into parecoxib group and control group（ n = 15 ）. The serum concentrations of TNF-α, IL-6 and IL-10 were determined before induction of anesthesia （T1 ） ,and 2h （T2 ） ,6 h （T3 ） ,12 h （T4） after operation. The VAS was recorded at T1 ,T2, T3 and T4. The MAP, HR and SpO2 were monitored. The adverse effects including atelectasis, pulmonary infection, serious cardiac arrhythmias, hypertension, myocardial infarction were observed within 24 h after operation. Results The concentrations of TNF-α,IL-6 and IL-10 in two group at T2 ,T3 ,T4 were all significantly higher than those at T1 （P 〈 0.05 ）. Compared with control group, the concentrations of TNF-ct and IL-6 were significantly lower, while IL-10 was significantly higher at T2 ,T3 ,T4 in the parecoxib group（ P 〈 0.05 ）. The VAS of pareeoxib group was significantly lower than that of control group at T2, T3, T4, respectively （ P 〈 0.05 ）. The MAP, HR, PaCO2 of control group at T2, T3, T4 were all significantly increased than that at T1 and those of parecoxib group at the same points（ P 〈 0.05 ）. The complications of parecoxib group including ateleetasis, pulmonary infection were significantly decreased（ P 〈 0.05 ）. Conclusion Pareeoxib eolud be effectively used for preemptive analgesia in old patients undergoing thoraeotomy with its regulation of immunologic balance and decreasing adverse effects,including atelectasis and pulmonary infection.

关 键 词：帕瑞昔布钠 开胸手术 炎性细胞因子 超前镇痛 

分 类 号：R614[医药卫生—麻醉学]