国际麻醉学与复苏杂志
國際痳醉學與複囌雜誌
국제마취학여복소잡지
INTERNATIONAL JOURNAL OF ANESTHESIOLOGY AND RESUSCITATION
2013年
6期
499-502
,共4页
曹文超%陈红%王国年%赵海芳
曹文超%陳紅%王國年%趙海芳
조문초%진홍%왕국년%조해방
帕瑞昔布钠%乳腺癌%超前镇痛%白细胞介素-6%C-反应蛋白
帕瑞昔佈鈉%乳腺癌%超前鎮痛%白細胞介素-6%C-反應蛋白
파서석포납%유선암%초전진통%백세포개소-6%C-반응단백
Parecoxib%Breast cancer%Preemptive analgesia%Interleukin-6%C-reactive protein
目的 探讨帕瑞昔布钠超前镇痛对乳腺癌改良根治术患者术后白细胞介素-6(interleukin-6,IL-6)与C反应蛋白(c-reactive protein,CRP)水平的影响,并评价其镇痛效果. 方法 选择拟全麻下行乳腺癌改良根治术患者60例,采用随机数字表法随机分为3组(每组20例):超前镇痛组(A组)、空白对照组(B组)和术后镇痛组(C组),分别在麻醉诱导前10 min或术毕时对A、C组患者静脉注射帕瑞昔布钠40 mg/2 ml.于麻醉诱导前10 min(T1)、术后1(T2)、6(T3)、24 h(T4)采集静脉血样,检测血清IL-6和CRP,并采用视觉模拟评分法(visual analog scales,VAS)进行术后疼痛评分. 结果 与术前基础值比较,3组患者血浆IL-6与CRP水平于术后1、6、24 h均有明显升高(P＜0.01)；B组术后l、6h和24 h逐渐升高,术后24 h水平与术后1h比较,差异有统计学意义(P＜0.01).组间比较:超前镇痛组术后T2、T3、T4时点IL-6水平分别为[(16.6±2.4)、(27.0±3.7)、(24.5±3.6) ng/L],低于空白对照组[(24.2±2.6)、(32.9±4.2)、(36.2±5.1) ng/L]和术后镇痛组[(20.8±2.7)、(29.4±3.9)、(31.9±4.4)ng/L] (P＜0.05)；超前镇痛组术后T2、T3、T4时点CRP水平分别为[(10.6±2.4)、(18.4±3.5)、(40.7±4.3)mg/L],低于空白对照组[(14.9±3.2)、(24.3±4.4)、(54.6±5.4) mg/L]和术后镇痛组[12.3±2.6)、(21.7±4.2)、(45.6±4.8) mg/L](P＜0.05).术后VAS评分A、C组术后1、2、4、6h分别为[(2.1±1.0)、(2.4±1.2)、(2.9±1.3)、(3.3±1.2)分],[(2.9±1.2)、(3.2±1.2)、(3.4±1.3)、(3.6±1.2)分]低于同时点B组,比较差异有统计学意义(P＜0.05),术后24 h内B组哌替啶应用次数及使用量明显高于A、C组(P＜0.05),A组未应用哌替啶,3组术后12、24 h视觉模拟评分法(visual analogue scales,VAS)评分差异无统计学意义. 结论 帕瑞昔布钠行超前镇痛可取得良好的镇痛效果,并能有效抑制术后IL-6和CRP水平升高,调控机体的炎症与应激反应,具有一定的免疫保护作用,促进患者术后恢复.
目的 探討帕瑞昔佈鈉超前鎮痛對乳腺癌改良根治術患者術後白細胞介素-6(interleukin-6,IL-6)與C反應蛋白(c-reactive protein,CRP)水平的影響,併評價其鎮痛效果. 方法 選擇擬全痳下行乳腺癌改良根治術患者60例,採用隨機數字錶法隨機分為3組(每組20例):超前鎮痛組(A組)、空白對照組(B組)和術後鎮痛組(C組),分彆在痳醉誘導前10 min或術畢時對A、C組患者靜脈註射帕瑞昔佈鈉40 mg/2 ml.于痳醉誘導前10 min(T1)、術後1(T2)、6(T3)、24 h(T4)採集靜脈血樣,檢測血清IL-6和CRP,併採用視覺模擬評分法(visual analog scales,VAS)進行術後疼痛評分. 結果 與術前基礎值比較,3組患者血漿IL-6與CRP水平于術後1、6、24 h均有明顯升高(P＜0.01)；B組術後l、6h和24 h逐漸升高,術後24 h水平與術後1h比較,差異有統計學意義(P＜0.01).組間比較:超前鎮痛組術後T2、T3、T4時點IL-6水平分彆為[(16.6±2.4)、(27.0±3.7)、(24.5±3.6) ng/L],低于空白對照組[(24.2±2.6)、(32.9±4.2)、(36.2±5.1) ng/L]和術後鎮痛組[(20.8±2.7)、(29.4±3.9)、(31.9±4.4)ng/L] (P＜0.05)；超前鎮痛組術後T2、T3、T4時點CRP水平分彆為[(10.6±2.4)、(18.4±3.5)、(40.7±4.3)mg/L],低于空白對照組[(14.9±3.2)、(24.3±4.4)、(54.6±5.4) mg/L]和術後鎮痛組[12.3±2.6)、(21.7±4.2)、(45.6±4.8) mg/L](P＜0.05).術後VAS評分A、C組術後1、2、4、6h分彆為[(2.1±1.0)、(2.4±1.2)、(2.9±1.3)、(3.3±1.2)分],[(2.9±1.2)、(3.2±1.2)、(3.4±1.3)、(3.6±1.2)分]低于同時點B組,比較差異有統計學意義(P＜0.05),術後24 h內B組哌替啶應用次數及使用量明顯高于A、C組(P＜0.05),A組未應用哌替啶,3組術後12、24 h視覺模擬評分法(visual analogue scales,VAS)評分差異無統計學意義. 結論 帕瑞昔佈鈉行超前鎮痛可取得良好的鎮痛效果,併能有效抑製術後IL-6和CRP水平升高,調控機體的炎癥與應激反應,具有一定的免疫保護作用,促進患者術後恢複.
목적 탐토파서석포납초전진통대유선암개량근치술환자술후백세포개소-6(interleukin-6,IL-6)여C반응단백(c-reactive protein,CRP)수평적영향,병평개기진통효과. 방법 선택의전마하행유선암개량근치술환자60례,채용수궤수자표법수궤분위3조(매조20례):초전진통조(A조)、공백대조조(B조)화술후진통조(C조),분별재마취유도전10 min혹술필시대A、C조환자정맥주사파서석포납40 mg/2 ml.우마취유도전10 min(T1)、술후1(T2)、6(T3)、24 h(T4)채집정맥혈양,검측혈청IL-6화CRP,병채용시각모의평분법(visual analog scales,VAS)진행술후동통평분. 결과 여술전기출치비교,3조환자혈장IL-6여CRP수평우술후1、6、24 h균유명현승고(P＜0.01)；B조술후l、6h화24 h축점승고,술후24 h수평여술후1h비교,차이유통계학의의(P＜0.01).조간비교:초전진통조술후T2、T3、T4시점IL-6수평분별위[(16.6±2.4)、(27.0±3.7)、(24.5±3.6) ng/L],저우공백대조조[(24.2±2.6)、(32.9±4.2)、(36.2±5.1) ng/L]화술후진통조[(20.8±2.7)、(29.4±3.9)、(31.9±4.4)ng/L] (P＜0.05)；초전진통조술후T2、T3、T4시점CRP수평분별위[(10.6±2.4)、(18.4±3.5)、(40.7±4.3)mg/L],저우공백대조조[(14.9±3.2)、(24.3±4.4)、(54.6±5.4) mg/L]화술후진통조[12.3±2.6)、(21.7±4.2)、(45.6±4.8) mg/L](P＜0.05).술후VAS평분A、C조술후1、2、4、6h분별위[(2.1±1.0)、(2.4±1.2)、(2.9±1.3)、(3.3±1.2)분],[(2.9±1.2)、(3.2±1.2)、(3.4±1.3)、(3.6±1.2)분]저우동시점B조,비교차이유통계학의의(P＜0.05),술후24 h내B조고체정응용차수급사용량명현고우A、C조(P＜0.05),A조미응용고체정,3조술후12、24 h시각모의평분법(visual analogue scales,VAS)평분차이무통계학의의. 결론 파서석포납행초전진통가취득량호적진통효과,병능유효억제술후IL-6화CRP수평승고,조공궤체적염증여응격반응,구유일정적면역보호작용,촉진환자술후회복.
Objective To investigate the preemptive analgesia of parecoxib sodium on interleukin-6 (IL-6) and C-reactive protein (CRP)level in patients undergoing radical excision of breast cancer,and to evaluate its analgesic effect.Methods Sixty ASA Ⅰ-Ⅱ patients undergoing radical excision of breast cancer were randomly divided into three groups(n=20):preemptive analgesia group(group A),blank control group(group B) and postoperative analgesia group(group C).Patients received intravenous parecoxib sodium 40 mg before 10 min(group A) or at the end of surgery(group C) or normal saline(group B).Blood samples were collected from all patients before anesthesia(T1) and at 1 h (T2),6 h (T3),24 h (T4) after surgery for assaying the plasma levels of interleukin-6 and C-reactive protein.Postoperative analgesic efficacy was assessed with visual analog scales (VAS).Results Compared with T1,the plasma levels of IL-6 and CRP were significantly higher at T2,T3 and T4 in all the three groups (P＜0.01).In group B,IL-6 and CRP levels were increased along with time progress,and were higher at T4 than at T2 (P＜0.01).The plasma levels of interleukin-6 in preemptive analgesia group at T2,T3,T4 time points were [(16.6±2.4),(27.0±3.7),(24.5 ±3.6) ng/L],lower than control group [(24.2±2.6),(32.9±4.2),(36.2±5.1) ng/L] and postoperative analgesia group [(20.8±2.7),(29.4±3.9),(31.9±4.4) ng/L] (P＜0.05).The plasma levels of C-reactive protein in preemptive analgesia group at T2,T3,T4 time points were [(10.6±2.4),(18.4±3.5),(40.7±4.3) mg/L],lower than control group [(14.9±3.2),(24.3±4.4),(54.6±5.4) mg/L] and postoperative analgesia group [12.3±2.6),(21.7±4.2),(45.6±4.8) mg/L] (P＜0.05).The VAS scores at both group A and C at 1,2,4,6 h,were [(2.1±1.0),(2.4±1.2),(2.9±1.3),(3.3±1.2)points],[(2.9±1.2),(3.2±1.2),(3.4±1.3),(3.6±1.2)points] lower than at the same time point of group B (P＜0.05).Pethidine consumption at 24 h after operation were higher in group B than in group A and group C (P＜0.05).The VAS scores were no significant differences at 12,24 h in three groups.Conclusions Preemptive analgesia with parecoxib can be achieved good analgesic effect and can effectively inhibit the postoperative of IL-6 and C-reactive protein level increased,regulate the body's inflammatory and stress response,possess immunization protection.,promote postoperative recovery.
