术前输注氟比洛芬酯对子宫切除术患者围术期血浆IL-6、IL-8、TNF-α的影响。

Effect ol Intravenous Injection of Flurbiprofen Axetil Before Hysterectomy on the Expression of IL- 6, IL-8 and TNF-α During Perioperative Period

【目的】探讨术前输注氟比洛芬酯（凯纷）对子宫切除术患者围术期血浆促炎因子白介素6（IL-6）、白介素8（IL-8）、肿瘤坏死因子α（TNF-α）的影响。【方法】择期行子宫切除术患者60例，ASAⅠ～Ⅱ级，随机分为凯纷组和芬太尼两组各30例。凯纷组在手术切皮前5min静脉输注凯纷1mg／kg，芬太尼组在手术切皮前5rain静脉输注芬太尼1μg／kg，术毕两组静脉自控镇痛（PCIA）。锁定时间15min，视觉模拟评分法（VAS）行术后12、24及48h静止和活动评分，分别在开放静脉前（T1）、手术结束时（T2）、术后24h（T3）、术后48h（L）采取外周静脉血4ml测定血浆IL-6、IL-8、TNF-α浓度。【结果】两组患者在各时间点的BP、HR、RR、SPOz差异无显著性（P〉0．05），两组患者在术后12h（T2）和术后24h（T3）活动时视觉模拟评分（vAS值）凯纷组低于芬太尼（P〈O．05）；两组IL-6、IL-8、TNF-α水平在T2时显著升高，与本组T1时比较差异具有显著性（P〈0．05）；组间比较差异不具有显著性（P〉0．05），在T3时比较凯纷组明显低于芬太尼组（P〈O．05），在T4时比较差异不具有显著性（P〉O．05）；两组TNF-α在T2时比较差异不具有显著性（P〉0．05），在T。和‘r4时凯纷组明显低于芬太尼组（P〈O．05）。【结论】术前输注凯纷能明显降低子宫切除术患者围术期血浆促炎因子IL-6、IL-8、TNF-α的水平，但不能减轻手术创伤激活了损伤部位的炎症细胞释放炎症介质。

[Objective]To explore the effect of intravenous injection of flurbiprofen axetil before hysterectomy on the expression of IL-6, IL- 8 and TNF-α during perioperative period. [Methods] Sixty elective hysterectomy patients were randomly divided into 2 groups with 30 cases for each. Flurbiprofen axetil group received intravenous injection of flurbiprofen axetil lmg /Kg at 5min before surgical incision and fentanyl group received intravenous injection of fentanyl 1μg/kg at 5min before surgical incision. Both groups received fentany 20〉g/kg/100 mL by patient-con trolled intravenous analgesia（PCIA） （bolus 0. 5 mL,lock time for 15min, back ground infusion at 2 ml/h）. Pain scales was assessed by visual analog scales（VAS） at 12,24,48h after surgery. Peripheral venous blood samples were respectively taken before anesthesia（T1 ）, at the end of operation（T2 ）, at 24h（T3 ） and 48h（T4 ） after.operation. The levels of IL-6, IL-8 and TNF-α in the plasma were detected. [Results]There was no significant difference in BP, HR,RR and SPO2 between two groups at all time points（ P 〈0.05）. The VAS of activity at 12h and 24h after operation in flurbiprofen axetil group was significantly lower than that in fentanyt group, and there was significant difference between two groups（ P 〈0.05）. The levels of IL-6, IL-8 and TNF-α in both groups increased the most high at T2 , and there was significant difference between at T1 and T2 （ P 〈0.05）. There was no significant differ- ence on the levels of II. 6 and IL-8 between two groups at T2 （ P 〉0.05）, but there was significant difference at T4（ P 〈0.05）. The levels of IL 6 and IL-8 at T4 in flurbiprofen axetil group were significantly lower than those in fentanyl group, but there was no significant difference（ P ~0.05）. There was no significant difference on the level of TNF ~ between two groups at Tz （ P ~0.05）. The level of TNF-α at T3 and T4 in flurbiprofen axetil group was significantly lower than that in fentanyl group, and there was significant difference between two groups（ P 〈0.05）. [Conclusion] Intravenous injection of flurbiprofen axetil before hysterectomy can decrease the expression of IL-6, IL-8 and TNF-α during perioperative period, but can not reduce the release of inflammation mediators in inflammatory cells caused by surgical trauma.