塞来昔布联合地佐辛对肺癌围术期患者疼痛、炎性反应和肺功能的影响  

Effects of celecoxib and dezocine on analgesia,inflammatory response and lung function in lung cancer patients during perioperative period

作　　者：赵扬[1,2] 陈亮[1] ZHAO Yang;CHEN Liang(Department of Thoracic Surgery,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of Cardiothoracic Surgery,Affiliated Hospital of Integrated Traditional Chinese and Western Medicine,Nanjing University of Chinese Medicine,Nanjing 210028,China)

机构地区：[1]南京医科大学第一附属医院胸外科,南京210029 [2]南京中医药大学附属中西医结合医院心胸外科,南京210028

出　　处：《西北药学杂志》2019年第5期661-666,共6页Northwest Pharmaceutical Journal

基　　金：江苏省自然科学基金项目(编号:BK20151584);江苏省六大人才高峰项目(编号:2015-WSW-028);江苏省省级重点研发专项(编号:BE2016790)

摘　　要：目的比较并探讨塞来昔布联合氟比洛芬酯和塞来昔布联合地佐辛对肺癌围术期患者疼痛、炎性反应和肺功能的影响。方法选取在医院行肺癌根治术的86例患者作为研究对象,采用随机数字表法将其随机均分为对照组和研究组各43例。麻醉诱导前和手术结束前10min时,对照组患者给予塞来昔布联合氟比洛芬酯,研究组患者给予塞来昔布联合地佐辛。比较2组患者的镇痛效果及治疗前后炎性反应和肺功能变化情况。结果(1)麻醉前(t0)2组患者平均动脉压(MAP)和心率(HR)比较差异无统计学意义(P>0.05),对照组气管插管成功后即刻(t1)的MAP和HR较t0显著升高,手术开始30min(t2)和手术结束时(t3)均较t1有所降低,拔管时(t4)再次显著升高(P<0.05);研究组t1~t4时的MAP和HR较为平稳,无明显变化,且研究组t1~t4时的MAP和HR均显著低于对照组(P<0.05)。(2)术后随时间的延长,2组患者视觉模拟疼痛评分(VAS)和Ramsay镇静评分呈逐渐降低的趋势,且术后2,4,6和12h研究组VAS评分和Ramsay镇静评分均显著低于对照组(P<0.05)。(3)麻醉前2组患者血清白介素-6(IL-6)、白细胞介素-10(IL-10)和肿瘤坏死因子-α(TNF-α)水平比较差异均无统计学意义,术毕TNF-α、IL-6和IL-10均较麻醉前明显升高,之后则开始下降,研究组术毕、术后12,24和48h的血清IL-10显著高于对照组,IL-6和TNF-α均显著低于对照组(P<0.05)。(4)术前2组患者的用力肺活量(FVC)、1s用力呼气量(FEV1)和最大呼气中段流量(MMEF)3项肺功能指标比较差异均无统计学意义(P>0.05),术后24和48h较术前均明显降低(P<0.05),但研究组术后上述3项肺功能指标均显著高于对照组(P<0.05)。(5)术后,2组患者头晕、恶心、呕吐、嗜睡和呼吸抑制等不良反应发生率比较差异无统计学意义。结论塞来昔布与地佐辛联合应用可有效缓解行肺癌根治术患者围术期疼痛,降低其应激反应,预防患者全麻苏醒期躁动,Objective To compare and explore the effects of celecoxib combined with flurbiprofen axetil and celecoxib combined with dezocine on pain,inflammatory response and pulmonary function in patients with lung cancer during perioperative period.Methods 86 patients who underwentradical resection of lung cancer in the hospital were randomly divided into the control group(43 cases)and study group(43 cases).Patients in the control group were given celecoxib combined with flurbiprofen axetil before anesthesia induction and 10 minutes before surgery,while patients in the study group were given celecoxib combined with dezocine.The analgesic effectand the changes of inflammatory response and pulmonary function before and after treatmentwere compared between the 2 groups.Results(1)Before anesthesia(t0),there was no significantdifference in mean arterial pressure(MAP)and heartrate(HR)between the 2 groups(P>0.05).In the control group,MAP and HR immediately after tracheal intubation(t1)were significantly higher than those att0.Atthe beginning of operation(t2)and the end of operation(t3),MAP and HR were lower than those att1,and atthe time of extubation(t4)were again higher than those att0(P<0.05).MAP and HR in the study group att1-t4 were stable and had no significantchange,and MAP and HR att1-t4 in the study group were significantly lower than those in the control group(P<0.05).(2)The visual analogue pain score(VAS)and Ramsay sedation score of the 2 groups decreased gradually with the prolongation of postoperative time,and the VAS score and Ramsay sedation score of the study group were significantly lower than those of the control group at2,4,6 and 12 h after surgery(P<0.05).(3)The levels of serum interleukin-6,interleukin-10 and tumor necrosis factor-alpha(TNF-α)were notsignificantly differentbetween the 2 groups before anesthesia.After operation,the levels of TNF-α,IL-6 and IL-10 were significantly higher than those before anesthesia,and then began to decrease.The levels of serum IL-10 in the study group were significantly hi

关 键 词：塞来昔布 地佐辛 氟比洛芬酯 肺癌根治术 疼痛 炎症反应 肺功能 

分 类 号：R971[医药卫生—药品]