氟比洛芬酯自控镇痛对食管癌患者免疫功能和应激的影响

Effects of flurbiprofen in postoperative analgesia on the stress response and immune function of the patients Undergoing esophagectomy

目的观察氟比洛芬酯复合芬太尼术后静脉自控镇痛对患者免疫功能和应激的影响。方法择期行食管癌根治术患者60例，随机分为3组（n=20）：F1组（术前氟比洛芬酯）、F2组（术后氟比洛芬酯）和C组（对照组）。分别在术后1、24、48h行视觉模拟评分（VAS），术前30min、术后1、2d采集患者静脉血栓测血浆去甲肾上腺素（NE）、促肾上腺皮质激素（ACTH〉、皮质醇（COS）、CD3^＋、CD4^＋、CD8^＋和CD4^＋／CD8^＋。结果（1）3组术后48hVAS评分比较差异无统计学意义（P〉0．05）；（2）NE：本后1d，F1组低于C组、F2组。ACTH：术后1d，F1组、F2组均低于C组；术后2d，F1组低于C组。COS：与术前相比均有明显增高。（3）CD3^＋T细胞：术后1d，F1组、F2组高于C组。CD4^＋T细胞：C组、R组在术后1d均有明显降低。CD4^＋／CD8^＋值：F1组在术后1d明显高于C组、F2组。结论氟比洛芬酯复合芬太尼用于术后镇痛，可降低患者术后应激水平、改善患者机体细胞免疫功能。

Objective To evaluate the effects of flurbiprofen axetil and fentanyl in postoperative analgesia on immune： function and stress response of the patients undergoing esophagectomy. Methods Sixty patients were randomly divided into three groups with：20 cases＇in each group, including Group Fl （pre-operative： flurbiprofen axetil 50mg, postoperative ：flurbiprofen axetil 50mg ＋ fentanyl 10μg/kg ＋ droperidol 2.5 mg）, F2 （postoperative： flurbiprofen axetil 100mg ＋ fentanyl 10μg/kg ＋ droperidol 2.5 mg）, and group C（ postoperative： fentanyl 10μg/kg ＋ droperidol 2.5 mg）. The VAS score was recorded at 1, 24, 48 hours after surgery. Blood samples were obtained-from peripheral vein for determination of NE, ACTH, COS, CD3^＋ , CD4^＋ , CD8^＋and CD4^＋ ＋/CD8^＋ at 30min before surgery, 1d, 2d after surgery. Results Patients in the three groups did not show any significant difference in the VAS scores （ P 〉 0. 05 ）. NE was significantly lower in group F1 than group F2 and group Cat 1 d after surgery （ P 〈 0. 05 ）. There were significantly decreased ACTH in group F2 and Flthan group C at ld after surgery（ P 〈0. 05）, and it was significantly decreased in group Fl than that in group C at 2d after surgery（ P 〈 0. 05）. COS was significantly decreased in group F1 than that group C at ld after surgery（ P 〈0. 05）. CD3^＋ T-lymphocytes were significantly higher in group F2 and F1 than that group C at lh after surgery（ P 〈0. 05）, and group F1 was significantly higher than group C at 2d after surgery （ P 〈 0. 05 ）. CD4^＋ T-lymphocytes were significantly increased in group Fl than that in group C and F2 at 1 d after surgery（ P 〈 0. 05）. CD8^＋ T-lymphocytes were no significantly change in 3 groups and at each time point（ P 〉0. 05）. CD4^＋/CD8^＋ were significantly higher in group F1 than that in group C and F2 at 1 d after surgery（ P 〈0. 05）. Conclusion Postoperative analgesia by, using flurbiprofen axetil and fentanyl can diminish the using dose of postoperative opoiod drug, it can decrease patient＇s postoperative stress level and improve patient＇s cellular immune function.