CAJ | 학술논문

目的评价帕瑞昔布钠对肺癌根治术老年病人术后炎性反应的影响.方法择期胸腔镜下行肺癌根治术病人41例,性别不限,年龄65～ 78岁,体重52 ～ 81 kg,ASA分级Ⅱ或Ⅲ级,采用随机数字表法,将病人随机分为2组:对照组(C组,n=20)和帕瑞昔布钠组(P组,n=21).麻醉诱导后气管插管,机械通气,麻醉维持:静脉输注瑞芬太尼和异丙酚,吸入七氟醚,间断静脉注射维库溴铵,维持脑电双频指数值40～ 50.P组分别于麻醉前30 min、术后12、24和36 h时肌肉注射帕瑞昔布钠40mg,C组分别给予等容量生理盐水.2组术后采用病人自控静脉镇痛,镇痛药物为吗啡,维持静息时VAS评分≤3分,记录吗啡用量及术后12、24、48 h时Ramsay镇静评分.分别于术前、术毕、术后12、24和48 h时采集中心静脉血样,测定血浆TNF-α和IL-8的浓度,于上述时点采集桡动脉血样,测定PaO2,计算肺泡-动脉氧分压差及氧合指数,记录术后2 d内肺部并发症的发生情况.结果与C组比较,P组吗啡用量、Ramsay镇静评分、血浆TNF-α、IL-8浓度、肺泡-动脉氧分压差和术后肺部并发症发生率降低,氧合指数升高(P＜0.05).结论帕瑞昔布钠可降低肺癌根治术老年病人术后炎性反应,从而改善术后呼吸功能和减少肺部并发症发生.
목적 평개파서석포납대폐암근치술노년병인술후염성반응적영향.방법 택기흉강경하행폐암근치술병인41례,성별불한,년령65～ 78세,체중52 ～ 81 kg,ASA분급Ⅱ혹Ⅲ급,채용수궤수자표법,장병인수궤분위2조:대조조(C조,n=20)화파서석포납조(P조,n=21).마취유도후기관삽관,궤계통기,마취유지:정맥수주서분태니화이병분,흡입칠불미,간단정맥주사유고추안,유지뇌전쌍빈지수치40～ 50.P조분별우마취전30 min、술후12、24화36 h시기육주사파서석포납40mg,C조분별급여등용량생리염수.2조술후채용병인자공정맥진통,진통약물위마배,유지정식시VAS평분≤3분,기록마배용량급술후12、24、48 h시Ramsay진정평분.분별우술전、술필、술후12、24화48 h시채집중심정맥혈양,측정혈장TNF-α화IL-8적농도,우상술시점채집뇨동맥혈양,측정PaO2,계산폐포-동맥양분압차급양합지수,기록술후2 d내폐부병발증적발생정황.결과 여C조비교,P조마배용량、Ramsay진정평분、혈장TNF-α、IL-8농도、폐포-동맥양분압차화술후폐부병발증발생솔강저,양합지수승고(P＜0.05).결론 파서석포납가강저폐암근치술노년병인술후염성반응,종이개선술후호흡공능화감소폐부병발증발생.
Objective To evaluate the effect of parecoxib on the inflammatory response after radical lung cancer surgery in elderly patients.Methods Forty-one ASA Ⅱ or Ⅲ elderly patients of both sexes,aged 65-78yr,weighing 52-81 kg,undergoing elective radical lung cancer surgery performed via a thoracoscope,were randomly divided into control group (group C,n =20) and parecoxib group (group P,n =21).Tracheal intubation was performed after induction of anesthesia.Anesthesia was maintained with intravenous infusion of remifentanil and propofol,inhalation of sevoflurane and intermittent intravenous boluses of vecuronium.Bispectral index value was maintained at 40-50.Group P received intramuscular parecoxib sodium 40 mg at 30 min before anesthesia and at 12,24 and 36 h after surgery.The equal volume of normal saline was given in group C.Both groups received patient-controlled intravenous analgesia with morphine after operation.VAS scores at rest were maintained ≤ 3.The consumption of morphine and Ramsay sedation score at 12,24 and 48 h after operation were recorded.Blood samples were taken from the central vein before surgery (T0),at the end of surgery (T1) and at 12,24 and 48 h after surgery (T2-4) for determination of plasma TNF-α and IL-8 concentrations.Blood samples were collected from the radial artery at T0-4 for determination of PaO2.Alveolar-arterial oxygen tension difference and oxygenation index were calculated.Pulmonary complications were recorded within 2 days after surgery.Results The consumption of morphine,Ramsay sedation score,plasma TNF-α and IL-8 concentrations,alveolar-arterial oxygen tension difference and incidence of pulmonary complications were significantly lower,and oxygenation index was significantly higher in group P than in group C (P ＜ 0.05).Conclusion Parecoxib can reduce the inflammatory response after radical lung cancer surgery in elderly patients,thus improving respiratory function and reducing pulmonary complications after surgery.