术前静脉注射氟比洛芬酯对开胸手术患者围术期血液β-内啡肽、前列腺素E2和细胞因子水平的影响

Effects of preincisional intravenous finrbiprofen axetil on plasma β-endorphin, prostaglandin E2 and serum cytoldnes in patients undergoing thoracotomy

目的评价术前静脉注射氟比洛芬酯对开胸手术患者围术期血液β-内啡肽（pEP）、前列腺素E2（PGE2）、肿瘤坏死因子-α（TNF-α）和白细胞介素-6（IL-6）水平的影响，探讨其超前镇痛的机制。方法拟在全身麻醉下行食管癌根治术患者30例，ASAⅡ级，随机分为2组（n=15）：氟比洛芬酯组（F组）和安慰剂对照组（C组）。采用双盲法分别于气管插管后（切皮前15min）静脉注射氟比洛芬酯100mg（10 ml）或脂肪乳剂10ml。术毕两组均静脉输注芬太尼0．2μg·kg^-1·h^-1术后镇痛。于麻醉诱导前（T1）、手术2h（T2）、术毕（T3）、术后2h（T4）、术后24h（T5）、术后48h（T6）采中心静脉血，采用放射免疫法测定血浆β-EP、PGE2浓度和血清TNF-α、IL-6浓度。记录术后24、48hVAS评分。结果与C组比较，F组术后24h及48hVAS评分明显降低（P〈0．01）；与T1相比，F组L2-6时β-EP、PGE2及IL-6水平差异无统计学意义（P〉0．05），T1时TNF-α水平升高（P〈0．05），C组围术期PGE2、IL-6及TNF-α水平均升高（P〈0．01），β-EP T3、T4时升高、T6时降低（P〈0．05）。与C组比较，F组围术期PGE2、IL-6及TNF-α水平降低，T6时β-EP升高（P〈0．01或0．05）。结论术前静脉注射氟比洛芬酯通过抑制PGE2、TNF-α及IL-6的产生，减轻开胸手术患者中枢性敏化作用，产生了确切的超前镇痛效应。

ObJective To investigate the effects of preincisional intravenous flurbiprofen axetil on plasma β-endorphin （β-EP）, prostaglandin E2 （PGE2）, serum TNF-α and IL-6 in patients undergoing thoracotomy. Methods Thirty ASA Ⅱ patients aged 45-64 yr weighing 50-90 kg undergoing radical esophagectomy for cancer were randomly divided into 2 groups （ n = 15 each） ： Ⅰ control group （C） and Ⅱ flurbiprofen group （F） received flurbiprefen axetil 100 mg intravenously at 15 min before skin incision. Anesthesia was induced with midazolam, fentanyl and propofol. Tracheal intubation was facilitated with succinylcholine. The patients were mechanically ventilated. PET CO2 was maintained at 35-45 mm Hg. Anesthesia was maintained with 1% -2 % isoflurane, propofol infusion （3 μg·kg^-1·h^-1） and intermittent IV boluses of vecuronium and fentanyl. Fentanyl 10 μg/kg in 100 ml of normal saline was continuously infused intravenously at 2.0 ml/h using AuBex infusion pump for postoperative analgesia. Blood samples were taken immediately before induction of anesthesia （ T1 , baseline）, at 2 h of operation （T2）, immediately after the end of operation （ T3 ）, 2 h, 24 h and 48 h after operation （ T4,5,6 ） for determination of plasma levels of β-EP, PGE2 and serum levels of TNF-α and IL-6. Results The two groups were comparable with respect to age, M/F sex ratio, body weight, the amount of anesthetic drugs consumed, the amount of blood loss and fluid infused. There were no significant changes in the plasma levels of β-EP and PGE, and serum levels of TNF-α and IL-6 during and after operation as compared with the baseline values at T1 in group F. While in group C the cohcentrations of plasma PGE, and serum TNF-α and IL-6 were all significantly increased during and after operation and were significantly higher than in group F. The plasma level of β-EP was at first significantly increased at T2-4 then decreased at T5- 6 in group C and was significantly lower at T6 in group C than in group F. Conclusion Preincisional Ⅳ flurbiprofen axetil can exert obvious pre-emptive analgesia through inhibiting the perioperative production of PGE2, TNF-α and IL-6 in patients undergoing thoracotomy.