【摘要】 目的探讨氟比洛芬酯联合芬太尼对肝癌患者术后镇痛、凝血功能及炎症因子的影响。方法将拟肝癌手术的患者60例随机分为三组,每组20例,分别为氟比洛芬酯组(A组)、芬太尼组(B组)、氟比洛芬酯联合芬太尼组(C组)。采用视觉疼痛模拟评分(VAS)法以及Ramsay镇静评分评价术后各时间点三组患者的镇痛镇静效果;采用放射免疫沉淀法检测三组血浆中血小板计数(PLT)、凝血酶原时间(PT)、激活部分凝血酶原时间(APTT)、纤维蛋白原(FIB);采用电化学发光法检测三组血浆中白细胞介素-6(IL-6)、白细胞介素-8(IL-8)水平。结果芬太尼组出现不良反应的发生率高于其他两组,与芬太尼组相比,其余两组出现恶心、呕吐、头晕、呼吸抑制反应的例数差异均具有意义(P <0.05)。患者术后视觉模拟评分结果显示,术后2 h芬太尼组(B组)高于氟比洛芬酯组(A组)、氟比洛芬酯联合芬太尼组(C组)(P <0.05);4 h后三组评分不具差异性(P>0.05)。Ramsay评分比较差异无统计学意义(P> 0.05)。不同时间点的PT、APTT、FIB、PLT的测定结果经比较无差异性(P> 0.05)。三组IL-6、IL-8浓度都有所升高,与术前30 min相比,氟比洛芬酯组在术后24 h IL-6经统计学分析发现,差异具有统计学意义(P <0.05);术后6 h IL-8差异具有统计学意义(P <0.05);芬太尼组在术后6 h、24 h其IL-6、IL-8具有明显差异性(P <0.05);氟比洛芬酯联合芬太尼组术后6 h IL-8具有差异性(P <0.05)。与芬太尼组相比,氟比洛芬酯组和氟比洛芬酯联合芬太尼组在术后6h IL-6含量水平差异具有统计学意义(P <0.05);氟比洛芬酯组和氟比洛芬酯联合芬太尼组在术后6 h、术后24 h其IL-8具有明显差异性(P <0.05)。结论通过对肝癌患者镇痛、凝血功能以及炎症因子水平的考察,氟比洛芬酯联合芬太尼能显著降低术后疼痛以及术后炎症反应状态,对患者凝血功能不影响,有利于患者术后的良好恢复。更多还原

【Abstract】 Objective To investigate the effect of flurbiprofen axetil combined with fentanyl on postoperative analgesia, coagulation function and inflammatory factors in patients with hepatocellular carcinoma. Methods Sixty patients undergoing hepatocellular carcinoma surgery were randomly divided into 3 groups of 20 in each group: flurbiprofen axetil group(A group), fentanyl group(B group), and flurbiprofen axetil combined with fentanyl group(C group). Visual acupressure simulation scale(VAS) and Ramsay sedation scale were used to evaluate the analgesic and sedative effects of the three groups at each time point. Radioimmuno-precipitation method was used to detect plasma platelet counts(PLT), prothrombin Time(PT), activated partial prothrombin time(APTT) and fibrinogen(FIB) in the three groups, Electrochemiluminescence detection of interleukin-6(IL-6), interleukin-8(IL) level of plasma-8 in three groups. Results The incidence of adverse reactions was higher in the fentanyl group than in the other two groups. Compared with the fentanyl group, the number of nausea, vomiting, dizziness, and respiratory depression reactions in other group were different(P < 0.05). The postoperative visual analogue scale results showed that the fentanyl group(B group) was higher than the flurbiprofen axetil group(A group) and flurbiprofen axetil combined with the fentanyl group(C group) 2 hours postoperatively(P < 0.05), the scores of the three groups were not different after 4 hours(P > 0.05). There was no significant difference in Ramsay scores(P > 0.05). The results of determination of PT, APTT, FIB and PLT at different time points showed no difference(P > 0.05). The concentrations of IL-6 and IL-8 increased in all three groups. Compared with 30 minutes before operation,the IL-6 was present statistical differences in the flurbiprofen group at 24 hours after surgery(P < 0.05); IL-8 levels were significantly different at 6 h postoperatively(P < 0.05); 6 h and 24 h postoperatively in fentanyl group, IL-6 and IL-8 were significantly different(P < 0.05); There was significant difference of IL-8 in flurbiprofen axetil combined with fentanyl at 6 h postoperatively(P < 0.05). Compared with fentanyl group, there was a statistically significant difference in the level of IL-6 in flurbiprofen group and flurbiprofen axetil combined with fentanyl group at 6 h(P < 0.05). Flurbiprofen axetil group and flurbiprofen axetil combined with fentanyl group had significant difference in IL-8 at 6 h and 24 h after operation(P < 0.05). Conclusion By investigating the analgesic, coagulation function and inflammatory factors in patients with hepatocellular carcinoma, flurbiprofen axetil combined with fentanyl can significantly reduce postoperative pain and postoperative inflammatory reaction state, and have no effect on coagulation function of patients, which is beneficial recovery to patients after surgery.更多还原