帕瑞昔布钠给药时机对腹腔镜下急性化脓性阑尾炎切除术患者术后炎性因子的影响  

Effect of the administration timing of parecoxib sodium on postoperative inflammatory factors of patients undergoing acute suppurative appendicitis surgery with laparoscopy

作　　者：蒋永[1] 谭忆[1] 张世勇[1] 林慧雯[1] 

机构地区：[1]内江市第一人民医院麻醉科,四川内江641000

出　　处：《安徽医药》2016年第8期1600-1603,共4页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨帕瑞昔布钠给药时机对腹腔镜下急性化脓性阑尾炎切除术患者术后炎性因子的影响,为预防及减轻急性化脓性阑尾炎手术围术期应激反应方法的选择提供参考。方法选取急性化脓性阑尾炎患者100例,按随机数字表法分为A组与B组,每组各50例,两组患者在入院后均急诊手术,芬太尼、依托咪酯、咪达唑仑及维库溴铵进行麻醉诱导,丙泊酚、瑞芬太尼麻醉维持,A组患者在麻醉诱导前静脉注射帕瑞昔布钠,B组患者在术毕时静脉注射帕瑞昔布钠。观察指标围手术期相关指标变化。结果两组患者手术时间、出血量、阿托品及麻黄碱使用率比较差异无统计学意义;白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、白细胞介素-10(IL-10)及肿瘤坏死因子α(TNF-α)水平,A组术前分别为(7.84±2.80)、(8.12±2.97)、(47.11±12.93)ng·L-1、(0.97±0.30)mg·L-1,术后24 h分别为(24.11±10.73)、(20.95±14.61)、(113.26±23.85)ng·L-1、(1.45±0.39)mg·L-1,B组术前分别为(7.91±2.45)、(8.04±3.05)、(44.72±13.65)ng·L-1、(0.99±0.37)mg·L-1,术后24 h分别为(32.73±13.64)、(33.47±23.74)、(95.60±21.39)ng·L-1、(1.94±0.86)mg·L-1,两组术后24 h时以上指标水平较术前升高(P<0.05),术后24 h时IL-6、IL-8及TNF-α水平低于B组(P<0.05),IL-10水平高于B组(P<0.05);两组术后24 h时VAS评分及24 h内自控镇痛泵按压次数比较差异无统计学意义。结论腹腔镜下急性化脓性阑尾炎切除术患者帕瑞昔布钠在麻醉诱导前给药较术毕给药更有利于降低术后炎性因子水平,提高抑炎因子浓度,用药时机对术后镇痛无影响。Objective To investigate the effect of the administration timing of parecoxib sodium on postoperative inflammatory factors of patients undergoing acute suppurative appendicitis surgery with laparoscopy,so as to provide reference for choosing methods of prevention and mitigation of perioperative stress response to acute suppurative appendicitis surgery. Methods A hundred patients of acute suppurative appendicitis were randomized intogroup A（ n = 50） and group B（ n = 50）. All of the patients underwent emergency surgery after admission. Fentanyl,etomidate,midazolam and vecuronium were taken for induction of anesthesia,and propofol and remifentanil were for the keeping of anesthesia. Group A received intravenous parecoxib sodium before induction of anesthesia,while group B received intravenous parecoxib sodium after surgery. The changes of relevant indicators of perioperative period were observed. Results There were no significant differences between the two groups in the operative time,blood loss,atropine and ephedrine usage. The Interleukin-6（ IL-6）,interleukin-8（ IL-8）,interleukin-10（ IL-10） and tumor necrosis factor-α（ TNF-α） levels in group A and group B were（ 7. 84 ± 2. 80） vs（ 7. 91 ± 2. 45）,（ 8. 12 ± 2. 97） vs（ 8. 04 ± 3. 05）,（ 47. 11 ± 12. 93） ng · L- 1vs（ 44. 72 ± 13. 65） ng·L- 1,（ 0. 97 ± 0. 30） mg·L- 1vs（ 0. 99 ± 0. 37） mg·L- 1before surgery,（ 24. 11 ± 10. 73） vs（ 32. 73 ± 13. 64）,（ 20. 95 ± 14. 61） vs（ 33. 47 ± 23. 74）,（ 113. 26 ± 23. 85） ng·L- 1vs（ 95. 60 ± 21. 39） ng·L- 1,（ 1. 45 ± 0. 39） mg·L- 1vs（ 1. 94 ± 0. 86） mg·L- 124 h after surgery. The above indicators in both groups were significantly increased 24 h after surgery compared to those before surgery（ P 〈 0. 05）. The IL-6,IL-8 and TNF-α levels 24 hours after surgery were lower in group A than in group B（ P 〈 0. 05）,while IL-10 was higher in group A than in group B（ P 〈 0. 05）. There were no significant differences in

关 键 词：阑尾炎 药物时间疗法 帕瑞昔布 白细胞介素6 白细胞介素8 白细胞介素10 肿瘤坏死因子α 

分 类 号：R614[医药卫生—麻醉学]