CAJ | 학술논문

目的：研究帕瑞昔布钠联合芬太尼镇痛对胃癌患者术后T细胞亚群和NK细胞的免疫保护作用。方法选择医院2014年1月至10月择期行胃癌根治术的患者124例，随机分为治疗组和对照组，各62例。治疗组患者于术前15 min及术毕缝皮前给予帕瑞昔布钠40 mg，对照组患者给予0.9%氯化钠注射液5 mL静脉注射，静脉自控镇痛( PCIA )泵内药物治疗组为芬太尼0.8 mg+昂丹司琼12 mg，对照组为芬太尼1.0 mg+昂丹司琼12 mg，镇痛时间为48 h。观察并记录术后不同时间点视觉模拟疼痛评分（VAS），检测不同时间点的T淋巴细胞亚群及NK细胞的水平；记录围术期不良反应发生情况。结果两组患者术后各时间点VAS评分均较低，镇痛满意，组间无明显差异（ P ？0.05）。两组患者的CD3+，CD4+，CD4+/CD8+及NK细胞（CD56+）水平在手术开始2 h（T1）较术前30 min（T0）下降（ P<0.05），且治疗组下降幅度明显低于对照组；两组上述指标在术后24 h（T2）仍低于T0，（ P<0.05），但治疗组回升幅度优于对照组（ P<0.05）；术后96 h（T3），两组上述指标继续回升，且治疗组回升幅度优于对照组，并接近术前水平（ P<0.05）。治疗组不良反应发生率为9.68%，明显低于对照组的22.58%（ P<0.05）。结论帕瑞昔布钠联合芬太尼在胃癌患者术后镇痛中镇痛效果可靠，能减少芬太尼的用量，对T细胞亚群和NK细胞具有免疫保护作用，值得临床推广。
목적：연구파서석포납연합분태니진통대위암환자술후T세포아군화NK세포적면역보호작용。방법선택의원2014년1월지10월택기행위암근치술적환자124례，수궤분위치료조화대조조，각62례。치료조환자우술전15 min급술필봉피전급여파서석포납40 mg，대조조환자급여0.9%록화납주사액5 mL정맥주사，정맥자공진통( PCIA )빙내약물치료조위분태니0.8 mg+앙단사경12 mg，대조조위분태니1.0 mg+앙단사경12 mg，진통시간위48 h。관찰병기록술후불동시간점시각모의동통평분（VAS），검측불동시간점적T림파세포아군급NK세포적수평；기록위술기불량반응발생정황。결과량조환자술후각시간점VAS평분균교저，진통만의，조간무명현차이（ P ？0.05）。량조환자적CD3+，CD4+，CD4+/CD8+급NK세포（CD56+）수평재수술개시2 h（T1）교술전30 min（T0）하강（ P<0.05），차치료조하강폭도명현저우대조조；량조상술지표재술후24 h（T2）잉저우T0，（ P<0.05），단치료조회승폭도우우대조조（ P<0.05）；술후96 h（T3），량조상술지표계속회승，차치료조회승폭도우우대조조，병접근술전수평（ P<0.05）。치료조불량반응발생솔위9.68%，명현저우대조조적22.58%（ P<0.05）。결론파서석포납연합분태니재위암환자술후진통중진통효과가고，능감소분태니적용량，대T세포아군화NK세포구유면역보호작용，치득림상추엄。
Objective To research the immune protection role of parecoxib sodium combined with fentanyl analgesia on postoperative T cell subsets and NK cells in patients with gastric cancer. Methods Totally 124 patients with gastric cancer undergoing elective radical surgery in the hospital from January to October 2014 were selected and randomly divided into the treatment group and the control group,62 cases in each group. The patients in the treatment group were given parecoxib sodium 40 mg at preoperative 15 min and be-fore the skin suture after the end of operation,while the control group received the intravenous injection of 0. 9% sodium chloride in-jection 5 mL. The PCIA pump drugs were fentanyl 0. 8 mg + ondansetron 12 mg in the treatment group and fentanyl 1. 0 mg + on-dansetron 12 mg in the control group with the analgesic time of 48 h. The visual analog scale(VAS)scores of pain at different postop-erative time points were observed and recorded. The levels of T lymphocyte subsets and NK cells at different time points were detect-ed;the occurrence situation of perioperative adverse reactions were recorded. Results The VAS scores at various postoperative time points in the two group were lower with satisfactory analgesia and without statistically significant difference between the two groups( P ? 0. 05). The levels of CD3 +,CD4+,CD4 + /CD8+ and NK cells(CD56+)at 2 h of operation start(T1)in the two groups were decreased compared with those at preoperative 30 min(T0),moreover the descend range of the treatment group was lower than that of the control group;the above indicators at postoperative 24 h(T2)in the two groups were still lower than those at T0( P < 0. 05),but the rising range of the treatment group was superior to that of the control group( P < 0. 05);these above-mentioned indicators at postoperative 96 h(T3) in the two groups continued to rise,moreover the ascend range in the treatment group was superior to that in the control group and close to the preoperative level( P < 0. 05);the occurrence rate of adverse reactions in the treatment group was 9. 68%,which was significant-ly lower than 22. 58% in the control group( P < 0. 05). Conclusion Parecoxib sodium combined with fentanyl has the reliable anal-gesic effect in the postoperative analgesia of the patients with gastric cancer,can reduce the fentanyl dosage,possesses the protective role on T cell subsets and NK cells and deserves to be clinically promoted.