围术期口服环氧化酶-2抑制剂对术后镇痛效果的影响

The effect of perioperative oral selective cyclooxygenase-2 inhibitor on postoperative analgesia following gynecological surgery

目的通过围术期口服选择性环氧化酶(COX)-2抑制剂,观察妇科术后患者的镇痛效果与血清中血栓素(TX)B2、前列腺素(PG)E2与脑脊液中PG水平的变化。方法60例择期行妇科手术者,随机分为3组,每组20例。A组:麻醉前1 h至术后48 h口服选择性COX-2抑制剂尼美舒利100 m g,1次/12 h;B组:麻醉前1 h至术后48 h内口服非选择性COX抑制剂布洛芬400 m g,1次/6 h;C组:不服用任何药物。分别于麻醉前,术后24、48 h测定脑脊液中6-酮PGF1α和血清中TXB2、PGE2水平。3组术后均采用静脉自控止痛泵(PCA)注射吗啡进行术后止痛,记录术后2、6、12、24、48 h的视觉模拟评分(VA S)和术后48 h累计吗啡需要量。结果术后48 hA组脑脊液中6-酮PGF1α水平与术前比较无差异,但明显低于B、C组(P<0.05);术后6、12、24 h,A组VA S评分和术后48h累计吗啡总需要量明显低于B、C组(P<0.05)。结论围术期口服选择性COX-2抑制剂比其他非甾体类抗炎药(N SA ID s)的镇痛效果好。

Objective： To observe the effect of perioperative oral selective cyclooxygenase-2 inhibitor on postoperative analgesia and concentration changes of TXB2 and PGE2 in serum and PG in cerebral spinal fluid following gynecological surgery. Methods： Sixty ASA Ⅰ-Ⅱ patients undergoing gynecological surgery were randomly divided into three groups,each of which included 20 cases： group A received the selective COX-2 inhibitor nimesulide 100mg orally twice daily from 1h before anaesthesia to 48h postoperatively; group B received the nonselective COX inhibitor ibuprofen 400mg orally four times daily from lh before anaesthesia to 48h postoperatively; group C did not receive any medicine during that period. CSF 2 ml and venous blood 6ml were collected respectively before anaesthesia ,on the first postoperative day and the second postoperative day. CSF was analyzed for 6-keto-PGF1 and venous blood for serum thromboxane （TX） B2 and PGE2. Postoperative analgesia was attained by intravenous PCA with morphine. The visual analog scale （VAS） was recorded respectively at 2, 6, 12, 24,48 h postoperatively. The cumulative consumption of morphine during postoperative 48h was also recorded. Results： Comparatively,the serum TX B2 levels were significantly inhibited by ibuprofen （ P 〈 0. 05）; the levels of PGE2 induced by LPS were significantly inhibited by nimesulide （ P 〈 0. 05） ; and both of them did not change in group C. The concentration of 6-keto-PGF1 in CSF in group A at 48h postoperatively had no differerice with that of before anaesthesia,and was significantly lower than that of the other two groups （P 〈 0. 05）. The VAS and cumulative consumption of morphine during postoperative 48h in group A were significantly lower than that of the other two groups （ P 〈 0.05）. Conclusion： Perioperative oral selective cyclooxygenase-2 inhibitor is better than other NSAIDs for postoperative analgesia.