氟比洛芬酯复合芬太尼对子宫切除术病人术后血浆IL-1β、IL-6、IL-8及皮质醇的影响

Effect of Intravenous Flurbiprofen Axetil Combined with Fentanly Analgesia on Serum IL-1β, IL-6,IL-8 and Cortisol after Hysterectomy

【目的】探讨氟比洛芬酯复合芬太尼病人自控静脉镇痛（PCIA）对子宫切除术病人术后VAS评分、不良反应、应激反应及血浆细胞因子的影响。【方法】选择ASAⅠ～Ⅱ级的子宫切除术患者30例，随机分为两组，氟比洛芬酯组（F组）、对照组（C组），每组15例。F组镇痛配方为氟比洛芬酯100mg和芬太尼10μg／kg用生理盐水稀释至100mL，负荷量为氟比洛芬酯1mg／kg。C组镇痛配方为芬太尼20μg／kg用生理盐水稀释至100mL，负荷量芬太尼50μg。记录两组不良反应发生情况，术后2h、6h、24h、48h、72hVAS评分情况。并于术前（T0）、术后24h（T1）、48h（T2）、72h（T3）抽取病人肘静脉血，检测血浆IL-1β、IL-6、IL-8、皮质醇含量。【结果】F组与C组VAs评分术后各时间点差异无统计学意义（P〉0．05），C组的恶心、呕吐发生率明显高于F组（P〈0．05）。C组与F组术前与术后各时间点血浆皮质醇、IL-1β水平变化无统计学意义。C组IL-6水平在T1、T2时升高较F组明显。C组IL-8水平在T1时升高较F组明显，差异有统计学意义。【结论】术后镇痛复合应用氟比洛芬酯和芬太尼与单纯应用芬太尼相比较，镇痛效果相近，且可减轻术后免疫抑制，不良反应发生率更低。

[Objective] To compare the effects of flurbiprofen axetil combined with fentanyl and fentanyl alone used through intravenous postoperatively on the scores of visual analogue scale （VAS） for pain, the incidence of side effects, stress response and the levels of serum cytokines in patients after hysterectomy. [Methods] Thirty cases under epidural anesthesia were randomly divided into the group C and group F with 15 cases in each group. The analgesia methods were flurbiprofen axetil 100 mg plus fentanily 10μg/kg （diluted to 100 ml with normal saline） in the group F, and fentanily 20μg/kg （diluted to 100 ml with normal saline） in the group C. The incidence of side effects was recorded. The VAS score was used to assess pain intensity at 2h, 6h, 24h, 48h and 72h after the completion of surgery. Plasma concentrations of IL-1β, IL-6 and cortisol were determined before the operation and 24h （T1）, 48h （T2）, 72h （T3） after skin incision. [Results] The VAS scores of two groups were not significantly different （ P〉0.05） . The incidence of side effects of group F was significantly lower than that of the group C （ P 〈0.05） . Plasma concentrations of IL-1β and cortisol were not significantly different between group C and F. The levels of serum IL-6 of the group F was significantly lower than that of group C on T1 and T2. The levels of serum IL 8 of group F was significantly lower than that of group C on T1. [Conclusion]Postoperatively intravenous flurbiprofen axetil combined with fentanyl has a good effect on analgesia and stress response, and can clearly reduce immunosuppression and the incidence of side effects.