帕瑞昔布钠超前镇痛对老年髋关节置换术后炎性细胞因子和应激反应的影响  

Effects of Parecoxib Sodium Preemptive Analgesia on Postoperative Inflammatory Cytokines and Stress Responses in Elderly Patients Undergoing Total Hip Replacement

作　　者：陈伟[1] 李卫[1] 谢东武[1] 饶清 王健[1] 

机构地区：[1]绵阳市中心医院麻醉科,四川绵阳621000

出　　处：《华西医学》2015年第6期1067-1070,共4页West China Medical Journal

摘　　要：目的观察帕瑞昔布钠超前镇痛对老年髋关节置换术后炎性细胞因子和应激激素水平的影响。方法2013年3月-12月选择美国麻醉医师协会分级I-Ⅱ级，年龄60～90岁，体质量≥50kg，因股骨颈骨折或股骨头无菌性坏死拟行单侧全髋关节置换术的患者60例，随机分为超前镇痛组（P组，n=30）和对照组（C组，n=30）。P组采用帕瑞昔布钠超前镇痛联合舒芬太尼患者自控镇痛，C组采用舒芬太尼患者自控镇痛。监测两组患者手术前后外周静脉血中炎性细胞因子白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF—a）的水平，以及应激激素皮质醇、肾上腺素和去甲肾上腺素的变化。结果p组患者术后外周静脉血中IL-6、TNF-α、皮质醇、肾上腺素和去甲肾上腺素的水平较C组降低，差异有统计学意义（P〈0．05）。结论帕瑞昔布钠超前镇痛能降低老年髋关节置换术后外周静脉血中炎性细胞因子和应激激素水平。Objective To investigate whether parecoxib sodium preemptive analgesia reduces inflammatory cytokines and stress hormones production in elderly patients after total hip replacement. Methods Sixty patients with American Society of Anesthesiologists Classification I - ]I undergoing total hip replacement for femoral neck fracture or aseptic necrosis of the femoral head, aged between 60 and 90 years with a body weight more than 50 kg, were randomly divided into preemptive analgesia group （group P, n=30） and control group （group C, n=30）. The patients in group P received parecoxib sodium 40 mg intravenously 30 min before skin incision, and another 20 mg 8 hours after the first administration. All the patients in the two groups received the administration of patient-controlled analgesia sufentanyl. We recorded blood levels of interleukin-6 （IL-6）, tumor necrosis factor alpha （TNF-α）, cortisol （COR）, adrenaline （AD） and noradrenaline （NAD） 30 min before skin incision, and 1 hour, 6 hours, 12 hours and 24 hours postoperatively. Results The blood levels of IL-6, TNF-α, COR, AD and NAD in group P at 1 hour, 6 hours, 12 hours or 24 hours postoperatively were significantly lower than those in group C （P 〈 0.05）. Conclusion Parecoxib sodium preemptive analgesia reduces postoperative inflammatory cytokines and stress hormones production in elderly patients undergoing total hip replacement.

关 键 词：超前镇痛 帕瑞昔布钠 细胞因子 应激反应 髋关节置换术 

分 类 号：R614[医药卫生—麻醉学]