CAJ | 학술논문

目的评价帕瑞昔布钠对乳腺癌根治术后布托啡诺病人自控静脉镇痛(PCIA)时细胞免疫功能的影响.方法择期行乳腺癌改良根治术女性病人60例,ASA分级Ⅰ或Ⅱ级,年龄36～ 60岁,体重48 ～ 82 kg,采用随机数字表法,将其分为2组(n=30):对照组(C组)和帕瑞昔布钠组(P组).术毕采用布托啡诺10 μg/kg行PCIA,背景输注速率2 ml/h,PCA量0.5 ml,锁定时间15 min.P组分别于术毕、术后12、24和36 h时静脉注射帕瑞昔布钠40 mg,C组给予等容量生理盐水.术后维持VAS评分≤4分；VAS评分≥5分时,静脉注射布托啡诺进行镇痛补救.分别于麻醉诱导前5 min、切皮后2h、术后6h、1、3和7d时,采集右颈内静脉血样,采用流式细胞仪检测T淋巴细胞亚群(CD3+、CD4+、CD8+)和NK细胞的水平,计算CD4+/CD8+.分别于术后2、6、12、24和48 h时,记录镇痛泵总按压次数、有效按压次数和镇痛补救药物用量.记录不良反应发生情况.结果与C组比较,P组镇痛泵总按压次数和镇痛补救药物用量减少,镇痛泵有效按压次数增多,术后ld时CD3+、CD4+、CD4+/CD8+和NK细胞水平降低(P＜0.05),不良反应发生率差异无统计学意义(P＞0.05).结论帕瑞昔布钠可增强术后布托啡诺PCIA的效果,减少其用量,从而改善乳腺癌根治术病人术后细胞免疫功能.
목적 평개파서석포납대유선암근치술후포탁배낙병인자공정맥진통(PCIA)시세포면역공능적영향.방법 택기행유선암개량근치술녀성병인60례,ASA분급Ⅰ혹Ⅱ급,년령36～ 60세,체중48 ～ 82 kg,채용수궤수자표법,장기분위2조(n=30):대조조(C조)화파서석포납조(P조).술필채용포탁배낙10 μg/kg행PCIA,배경수주속솔2 ml/h,PCA량0.5 ml,쇄정시간15 min.P조분별우술필、술후12、24화36 h시정맥주사파서석포납40 mg,C조급여등용량생리염수.술후유지VAS평분≤4분；VAS평분≥5분시,정맥주사포탁배낙진행진통보구.분별우마취유도전5 min、절피후2h、술후6h、1、3화7d시,채집우경내정맥혈양,채용류식세포의검측T림파세포아군(CD3+、CD4+、CD8+)화NK세포적수평,계산CD4+/CD8+.분별우술후2、6、12、24화48 h시,기록진통빙총안압차수、유효안압차수화진통보구약물용량.기록불량반응발생정황.결과 여C조비교,P조진통빙총안압차수화진통보구약물용량감소,진통빙유효안압차수증다,술후ld시CD3+、CD4+、CD4+/CD8+화NK세포수평강저(P＜0.05),불량반응발생솔차이무통계학의의(P＞0.05).결론 파서석포납가증강술후포탁배낙PCIA적효과,감소기용량,종이개선유선암근치술병인술후세포면역공능.
Objective To evaluate the effects of parecoxib on cellular immune function during patientcontrolled intravenous analgesia (PCIA) with butorphanol after modified radical mastectomy in patients.Methods Sixty ASA physical status Ⅰ or Ⅱ patients,aged 36-60 yr,weighing 48-82 kg,scheduled for elective modified radical mastectomy,were randomly divided into 2 groupe (n =30 each):control group (group C) and parecoxib group (group P).PCIA with butorphanol 10μg/kg was used at the end of operation.The PCIA pump was set up to deliver a 0.5 ml bolus dose with a 15-min lockout interval and background infusion at 2 ml/h.In group P,parecoxib 40 mg was injected intravenously at the end of operation and 12,24 and 36 h after surgery,while in group C,the equal volume of normal saline was injected.VAS score was maintained at ≤4.When VAS score≥5,butorphanol was injected intravenously as a rescue analgesic.Blood samples were obtained from the right internal jugular vein at 5 min before induction of anesthesia,2 h after skin incision,and 6 h and 1,3,7 days after surgery for determination of the levels of T lymphocyte subsets (CD3+,CD4+,CD8+,CD4+/CD8+) and natural killer (NK) cells (by flow cytometry).CD4+/CD8+ was calculated.The number of attempts,the number of successfully delivered doses and requirement for rescue analgesics were recorded at 2,6,12,24 and 48 h after surgery.Adverse effects were also recorded after surgery.Results Compared with group C,the number of attempts and requirement for rescue analgesics were significantly decreased,the number of successfully delivered doses was increased,and the levels of CD3+,CD4+,CD4+/CD8+ and NK cells were decreased at 1 day after surgery (P ＜ 0.05).There was no significant difference in adverse effects between the two groups (P ＞ 0.05).Conclusion Parecoxib can enhance the efficacy of postoperative PCIA with butorphanol and reduce the consumption of butorphanol thus improving cellular immune function after modified radical mastectomy in the patients.