CAJ | 학술논문

目的观察氟比洛芬酯预给药在小儿扁桃体摘除术后镇痛的效果及其对术后IL-6、IL-10、TNF-α表达的影响.方法选取择期行扁桃体摘除术的患儿90例,ASA Ⅰ～Ⅱ级,随机将其分为三组,每组30例,Ⅰ组为预给药组,于手术前30 min单次应用氟比洛芬酯1 mg/kg;Ⅱ组为术后给药组,于手术结束时单次应用氟比洛芬酯1 mg/kg;Ⅲ组为空白对照组,给予生理盐水5 ml.观察术前、术后1h、2h、4h、8h、12h、24 h VAS疼痛评分和OPS评分.分别于麻醉诱导前、切皮后6h、12h、24 h抽取外周静脉血2ml,离心后取血浆,测定IL-6、IL-10、TNF-α浓度.结果与Ⅲ组比较,Ⅰ组、Ⅱ组术后各时点VAS疼痛评分、OPS评分均降低；与Ⅱ组比较,I组术后各时点VAS疼痛评分较低,I组术后4h、8h、12 h、24 h OPS评分较低低.与术前比较,Ⅰ组、Ⅱ组IL-10、TNF-α于术后6h升高,术后12h达到峰值,术后48 h恢复到术前水平,而IL-6 Ⅰ组仅于术后12h显著高于术前,Ⅱ组术后12h、24 h显著高于术前(P＜0.05)；与Ⅲ组比较,IL-10、TNF-α Ⅰ组和Ⅱ组于术后6h、12h、24 h显著低于Ⅲ组(P＜0.05),IL-6 Ⅰ组于术后12h显著低于Ⅲ组,Ⅱ组术后12 h、24 h显著低于Ⅲ组(P＜0.05)；与Ⅱ组比较,Ⅰ组IL-10、TNF-α于术后6h、12h、24 h均显著低于Ⅱ组,IL-6术后12h显著低于Ⅱ组(P＜0.05).结论术前或术后给予氟比洛芬酯用于小儿扁桃体摘除术能有效的抑制炎症反应,镇痛效果确切,并且预给药明显优于术后给药.
목적 관찰불비락분지예급약재소인편도체적제술후진통적효과급기대술후IL-6、IL-10、TNF-α표체적영향.방법 선취택기행편도체적제술적환인90례,ASA Ⅰ～Ⅱ급,수궤장기분위삼조,매조30례,Ⅰ조위예급약조,우수술전30 min단차응용불비락분지1 mg/kg;Ⅱ조위술후급약조,우수술결속시단차응용불비락분지1 mg/kg;Ⅲ조위공백대조조,급여생리염수5 ml.관찰술전、술후1h、2h、4h、8h、12h、24 h VAS동통평분화OPS평분.분별우마취유도전、절피후6h、12h、24 h추취외주정맥혈2ml,리심후취혈장,측정IL-6、IL-10、TNF-α농도.결과 여Ⅲ조비교,Ⅰ조、Ⅱ조술후각시점VAS동통평분、OPS평분균강저；여Ⅱ조비교,I조술후각시점VAS동통평분교저,I조술후4h、8h、12 h、24 h OPS평분교저저.여술전비교,Ⅰ조、Ⅱ조IL-10、TNF-α우술후6h승고,술후12h체도봉치,술후48 h회복도술전수평,이IL-6 Ⅰ조부우술후12h현저고우술전,Ⅱ조술후12h、24 h현저고우술전(P＜0.05)；여Ⅲ조비교,IL-10、TNF-α Ⅰ조화Ⅱ조우술후6h、12h、24 h현저저우Ⅲ조(P＜0.05),IL-6 Ⅰ조우술후12h현저저우Ⅲ조,Ⅱ조술후12 h、24 h현저저우Ⅲ조(P＜0.05)；여Ⅱ조비교,Ⅰ조IL-10、TNF-α우술후6h、12h、24 h균현저저우Ⅱ조,IL-6술후12h현저저우Ⅱ조(P＜0.05).결론 술전혹술후급여불비락분지용우소인편도체적제술능유효적억제염증반응,진통효과학절,병차예급약명현우우술후급약.
Objective To evaluate the influence of the preadministration of flurbiprofen axetil on the postoperative analgetic efficacy and inflammatory cytokine expression in children undergoing tonsillectomy.Methods 90 patients,ASA Ⅰ ～ Ⅱ,undergoing tonsillectomy were randomly divided into a preemptive analgesia group (group Ⅰ),a postoperative analgesia group (group Ⅱ),and a control group (group Ⅲ),30 patients for each group.Group Ⅰ singly administrated flurbiprofen axetil 1 mg/kg 30 minutes before the surgery; group Ⅱ administrated flurbiprofen axetil 1 mg/kg at the end of the surgery; group Ⅲ took normal saline 5 ml.VAS pain score and OPS score were recorded before and 1 h,2 h,4 h,8 h,12 h,and 24 h after the surgery.2 ml peripheral venous blood was collected before the induction of anesthesia and 6 h,12 h,and 24 h after skin incision.The plasma was obtained and stored for determining the concentrations of IL-6,IL-10,and TNF-α.Results VAS pain score and OPS score were lower in group Ⅰ and group Ⅱ than in group Ⅲ at each time point after the surgery (P ＜ 0.05).Compared with group Ⅱ,VAS pain score decreased at each time point after the operation in group Ⅰ,while OPS score reduced at 4 h,8 h,12 h,and 24 h after the surgery in group Ⅰ (P ＜ 0.05).Comparing with that before the surgery,TNF-α and IL-10 in group Ⅰ and group Ⅱ increased from 6 h after surgery and reached the peak 12 h after the surgery,then returned to the level before the surgery 48 h after the surgery,while IL-6 diminutively increased only 12 h after the surgery in group Ⅰ and 12 h,24 h after the surgery in group Ⅱ (P ＜ 0.05).Compared with group Ⅲ,IL-10 and TNF-α markedly decreased 6 h,12 h,and 24 h after the surgery in group Ⅰ and group,and IL-6 markedly decreased 12 h after the surgery in group Ⅰ and 12 h and 24 h after the surgery in group Ⅱ (P ＜ 0.05).Compared with group Ⅱ,IL-10 and TNF-α markedly lowered 6 h,12 h,and 24 h after the surgery in group Ⅰ,and IL-6 markedly decreased 12 h after the surgery in group Ⅰ (P ＜ 0.05).Conclusions Preoperatively or postoperatively administrating flurbiprofen axetil for pediatric tonsillectomy can effectively inhibit inflammation and provide effective analgesia.However,preadministration is far better than postoperative administration.