【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10 min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30 min（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12 h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48 h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）、1 s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48 h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,还可降低术后肺组织炎症反应,有效减轻肺损伤,减少对患者肺功能的影响。更多还原

【Abstract】 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 underwent radical 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 effect and the changes of inflammatory response and pulmonary function before and after treatment were compared between the 2 groups.Results（1）Before anesthesia（t₀）,there was no significant difference in mean arterial pressure（MAP） and heart rate（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 at t₀.At the beginning of operation（t₂） and the end of operation（t₃）,MAP and HR were lower than those at t₁,and at the time of extubation（t₄） were again higher than those at t₀（P<0.05）.MAP and HR in the study group at t₁-t₄ were stable and had no significant change,and MAP and HR at t₁-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 at 2,4,6 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 not significantly different between 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 higher than those of the control group after operation,12,24 and 48 h after operation,while IL-6 and TNF-α were significantly lower than those in control group（P<0.05）.（4）There was no significant difference between the 2 groups in FVC,FEV1 and MMEF before operation（P>0.05）.The lung function indexes of the 2 groups were significantly lower at 24 h after operation and 48 h after operation（P<0.05）,but the above 3 indexes of the study group were significantly higher than those in control group（P<0.05）.（5） There was no significant difference in the incidence of dizziness, nausea, vomiting, sleepiness and respiratory depression between the two groups.Conclusion Celecoxib combined with dezocine can effectively alleviate perioperative pain,reduce stress response,prevent restlessness during recovery period of general anesthesia in patients with lung cancer undergoing radical resection,it can reduce postoperative lung inflammation,effectively reduce lung injury,and reduce the impact on lung function.更多还原