【摘要】 目的探讨帕瑞昔布钠超前镇痛对肺癌全胸腔镜肺叶切除术患者血浆炎性细胞因子及氧合指数的影响。方法选择2010年6月～2012年5月因肺癌在全麻下行全胸腔镜肺叶切除术患者56例,性别不限,年龄50～70岁,ASA分级Ⅱ～Ⅲ级,随机双盲法分为2组(n=28):帕瑞昔布钠组(P组)和生理盐水对照组(C组)。麻醉诱导前,P组将帕瑞昔布钠40 mg以生理盐水2 ml稀释静脉注射,C组静脉注射等量生理盐水。2组术中均采用丙泊酚、瑞芬太尼维持麻醉,术后均采用吗啡自控静脉镇痛24小时。主要观察指标:术中丙泊酚及瑞芬太尼用量、术后24 h吗啡用量;麻醉诱导前(T0)、术毕(T1)、术后2 h(T2)、术后6 h(T3)及术后24 h(T4)从颈内静脉采血,检测血浆炎性细胞因子,包括白细胞介素6(IL-6)、IL-8、IL-10及肿瘤坏死因子α(TNF-α)水平;在T0、T2、T3、T4时采集动脉血样,测定PaO2,计算氧合指数(PaO2/FiO2)。结果 (1)与C组比较,P组术中瑞芬太尼用量和术后24 h吗啡用量少(P<0.01),术中丙泊酚用量差异无显著性(P>0.05)。(2)与T0时比较,2组在T1、T2、T3、T4时各血浆炎性细胞因子(IL-6、IL-8、IL-10、TNF-α)水平均显著升高(P<0.01);2组比较,P组IL-6、IL-8和TNF-α水平在T1、T2、T3、T4时低于C组(P<0.05),IL-10高于C组(P<0.01)。(3)与T0时比较,C组PaO2/FiO2在T2、T3、T4时降低(P<0.01),P组PaO2/FiO2仅在T3时降低(P<0.01);2组比较,P组PaO2/FiO2在T2、T3、T4时高于C组(P<0.05)。结论帕瑞昔布钠超前镇痛抑制全胸腔镜肺叶切除术后血浆促炎细胞因子释放,促进抑炎细胞因子释放,提高氧合指数,具有肺保护作用。更多还原

【Abstract】 Objective To investigate the effects of parecoxib sodium preemptive analgesia on plasma inflammatory cytokines and PaO2/FiO2 of the patients undergoing lobectomy of the lung with total video-assisted thoracoscopy.Methods From June 2011 to May 2012,56 patients of both sexes,diagnosed with lung cancer,aged 50-70 years,ASA physical status Ⅱ-Ⅲ,undergoing lobectomy of the lung with total video-assisted thoracoscopy,were randomly divided into control group(group C,n=28) and parecoxib group(group P,n=28).In group P,parecoxib sodium 40 mg diluted with 2 ml saline was given by intravenous injection before anesthesia introduction.In group C,equal saline was given concurrently.Patients in both groups received propofol-remifentanil anesthesia and patient-controlled intravenous analgesia with morphine for 24 hours.Primary observation indexes were:(1) consumption of propofol,remifentanil and morphine;(2)plasma level of IL-6,IL-8,IL-10 and TNF-α measured before anesthesia introduction(T0),at the end of the surgery(T1) and 2 hours,6 hours,24 hours after surgery(T2,T3,T4);(3) the PaO2/FiO2 at T0,T2,T3,T4.Results(1)Compared with group C,the consumption of remifentanil and morphine was decreased significantly in group P(P<0.01) and no significant difference was found in propofol amount(P>0.05).(2) The plasma level of IL-6,IL-8,IL-10 and TNF-α increased at T1,T2,T3,T4 as compared to those at T0 in both groups(P<0.01).Compared with group C,the level of IL-6,IL-8 and TNF-α were was lower at T1,T2,T3,T4 in group P(P<0.05),while the level of IL-10 was higher(P<0.01);(3) The PaO2/FiO2 decreased significantly at T2,T3,T4 as compared to those at T0 in group C,and only decreased significantly at T3 as compared to those at T0 in group P(P<0.01).Compared with group C,the PaO2/FiO2 increased at T2,T3,T4 in group P(P<0.05).Conclusion Parecoxib sodium preemptive analgesia can reduce postoperative plasma levels of pro-inflammatory cytokines,improve the level of suppression inflammatory cytokines and PaO2/FiO2 in patients undergoing lobectomy of lung with total video-assisted thoracoscopy.更多还原