【摘要】 目的:探讨氯诺昔康超前镇痛对术后免疫功能的影响。方法:24例在全身麻醉下行胆囊切除、胆总管切开取石、T管引流的病人,随机分为两组。超前镇痛组:Ⅰ组在麻醉诱导前30分钟静脉推注氯诺昔康0.12 mg/kg,手术开始后以微量泵静脉持续输入氯诺昔康0.02 mg/(kg.h),手术结束后以PCA泵静脉持续输入芬太尼,至术后两天;术后镇痛组:Ⅱ组在术前和术中以生理盐水替代氯诺昔康,手术结束后静脉持续输入芬太尼至术后两天。记录患者术后6 h、12 h、24 h及48 hVAS评分;分别于术前30 m in、术后24 h测血浆中皮质醇、β-内啡肽浓度,血液中CD3+、CD4+、CD8+标志细胞百分率。记录患者术后三天恶心、呕吐、头晕的发生率。结果:(1)术后各时间段Ⅰ组疼痛评分与Ⅱ组比较无显著差异(P>0.05)。(2)Ⅰ组术后皮质醇、β-内啡肽浓度低于Ⅱ组(P<0.05)。(3)Ⅰ组术后CD3+、CD4+细胞百分率、CD4+/CD8+均高于Ⅱ组(P<0.05),其CD8+细胞百分率与Ⅱ组比较无显著差异(P>0.05)。(4)两组恶心、呕吐及头晕的发生率无差异。结论:氯诺昔康超前镇痛能有效的抑制应激反应,减轻术后免疫抑制。更多还原

【Abstract】 Objective: To evaluate the effects of preemptive analgesia with lornoxicam on immunologic function of postoperative patients.Methods: A prospective study of 24 patients undergoing cholecystectomy,choledocholithotomy and T tube drainage was designed.Patients were randomized to preemptive group(group Ⅰ) and postoperative group(group Ⅱ).Patients in group Ⅰ were given lornoxicam 0.12 mg/kg iv before the induction of anesthesia.When the operation started,lornoxicam 0.02 mg/(kg·h) were administered.After the operation,fentanyl was administered via PCA for up to 48 hours.In group Ⅱ,lornoxicam was substituted by saline before the induction of anesthesia and in the operation.After the operation,fentanyl was administered via PCA for up to 48 hours.The parameters collected included:(1) VAS score at 6,12,24 and 48 hours after surgery;(2) Blood samples were obtained 30 min before the operation and 24 h after surgery.The levels of plasma corticoid,β-endorphin and the number of CD3~+,CD4~+,CD8~+ subset were measured;(3) Adverse events.Results:(1) There was no significant difference between group Ⅰ and group Ⅱ in pain scores.(2)After surgery,the levels of plasma corticoid and β-endorphin in group Ⅱ were higher than that of group Ⅰ(P<0.05).(3) After surgery,the number of CD3~+,CD4~+ subset and CD4~+/CD8~+ in group Ⅱ were lower than that of group Ⅰ.There was no difference between the two groups in the number of CD8~+ subset;(4) There were no difference in vomiting,nausea and vertigo between the two groups.Conclusion: Preemptive analgesia with lornoxicam can better inhibit the declination of immunologic function on postoperative patients.更多还原