氟比洛芬酯术后镇痛对血浆细胞因子和应激反应的影响

Effects of flurbiprofen for postoperative analgesia on plasma cytokine and stree response

目的研究氟比洛芬酯术后镇痛对妇科腹腔镜手术患者血浆细胞因子和应激反应的影响。方法选择ASAⅠ或Ⅱ级妇科腹腔镜手术患者62例，随机分为氟比洛芬酯组（F组，n=33）和哌替啶组（P组，n=29），分别于麻醉前（T0）、镇痛后30min（T1）、2h（T2）、6h（T3）和24h（T4）观察术后镇痛效果。采肘静脉血，放免法测血浆白细胞介素6（IL-6）、肿瘤坏死因子α（TNFαa）、皮质醇（Cor）、血栓烷B2（TXB2）和6-酮-前列腺素（6-Keto—PGF1α）水平。结果F组血浆IL-6水平T1～T3时和T0时比较差异无统计学意义。两组T1～T4时TNF-α值均显著升高（P〈0．05），但F组T2、T3时血浆IL-6、TNF-α水平均显著低于P组（P〈0．05）；F组血浆Cor水平镇痛前后差异无统计学意义，且T2、T3时显著低于P组（P〈0．05）；F组镇痛后TXB2、6-Keto—PGF1α水平均显著降低（P〈0．05），T2、T3时TXB2水平显著低于P组（P〈0．05），T1～T3时6-Keto—PGF1α水平显著低于P组（P〈0．05）。P组T2～T4时VAS显著高于T0时（P〈0．05），但F组仅T4时VAs显著高于T0时（P〈0.05），且T3时F组VAs低于P组（P〈0．05）。结论氟比洛芬酯有较好的平衡细胞因子和抑制过度应激反应作用，缓解术后的免疫损伤和炎症反应，具有良好的镇痛效果。

Objective To study the effects of flurbiprofen for postoperative analgesia on plasma cytokine and stree response in gynecological patients undergoing laparoscopy operation. Methods Sixty-two ASA class Ⅰ or Ⅱ gynecological patients undergoing laparoscopy operation were randomly divided into two groups. Thirty-three patients （group F ） were given flurbiprofen for postoperative analgesia and another twenty-nine patients （group P） were given pethidine. Venous blood samples were taken before analgesia （T0）,at 30 min （T1）, 2 h（T2 ）, 6 h（T3 ）, 24 h（T4 ） during analgesia for detecting plasma inter-Leukin 6 （IL-6）, tumor necrosis factor α （ TNF-α）, cortisol （Cor）, thromboxane B2 （TXB2）,6-Keto-PGF1α. The effects of postoperative analgesia were observed. Results There were no significant differences in plasma IL-6 level among T2 ,T3 and T0 in group F. IL-6 and TNF-α levels were significantly lower in group F than those in group P at T2, T2 （P〈0.05）. There were no significant differences in plasma Cor level among the time points in group F, which was significantly lower in group F than that in group P at T2 ,T3 （P〈0.05）. TXB2 and 6-Keto-PGF1α levels during analgesia were significantly lower than those at To. VAS pain scores were significantly lower in group F than those in group P at T3. Conclusion Flurbiprofen has a good postoperative analgesic effect,can effectively reduce cytokine level and prevent stree response.