帕瑞昔布钠对乳腺癌患者术后镇痛效果和应激反应的影响

Influence of parecoxib on analgesic effect and stress response in patients after radical excision of breast cancer

目的研究帕瑞昔布钠对乳腺癌改良根治术患者术后镇痛效果和应激反应的影响。方法根据美国麻醉师协会(ASA)分级,选择ASAⅠ～Ⅱ级择期行全麻下乳腺癌改良根治术患者60例,随机分为帕瑞昔布钠组和对照组。两组均采用布托啡诺行自控静脉镇痛,帕瑞昔布钠组于术毕即刻、术后12、24、36h分别静脉注射帕瑞昔布钠40mg;对照组在各时点给予生理盐水5ml。于麻醉前(T0)、术后2h(T1)、12h(T2)、24h(T3)、48h(T4)抽静脉血,用放免法测定血浆肾素、血管紧张素Ⅱ、醛固酮、皮质醇浓度,于T1到T4点记录视觉模拟镇痛评分(visual analogue scale,VAS).采用t检验和重复测量方差分析法进行统计学分析。结果帕瑞昔布钠组VAS于T2、T3、T4时明显低于对照组(P<0.05);帕瑞昔布钠组血浆肾素、血管紧张素Ⅱ、醛固酮、皮质醇浓度于T2、T3、T4时与T0比较差异无统计学意义(P>0.05),而对照组各指标T2、T3较T0明显增高(P<0.05);帕瑞昔布钠组与对照组比较各相指标在T2、T3显著降低(P<0.05)。结论联合应用帕瑞昔布钠术后镇痛效果完善,并可抑制术后机体应激反应,对于缓解乳腺癌根治患者术后免疫损伤和炎症反应有一定帮助。

Objective To investigate the influence of parecoxib on analgesic effect and stress response in breast cancer patients treated with modified radical mastectomy. Methods According to American Society of Anesthesiologists （ASA）grade, 60 breast cancer patients with ASA Ⅰ or Ⅱ undergoing modified radical mastectomy were selected and randomly divided into 2 groups： the parecoxib group （n= 30） and the control group （n= 30）. All patients received intravenous analgesia （PCIA） with butorphanol. In the parecoxib group, 40 mg parecoxib was administered at the end of the surgery and 12 h , 24 h and 36 h after surgery. The control group received iv saline 5 ml at the same time points. Renin activity, angiotensin If, aldosterone and cortisol in plasma in each group were measured immediately before induction of anesthesia （TO） and 2 h （T1）, 12 h （T2）, 24 h （T3） and 48 h （T4） after operation. The analgesic effect assessed by visual analog scale （VAS） at T1, T2, T3 and T4. Repeated measures analysis of variance and t test were used for statistical analysis. Results The VAS pain scores in the parecoxib group were significantly lower than those in the control group at T2, T3 and T4, respectively （P〈0.05）. There was no significant difference in the concentrations of plasma renin activity, angiotensin Ⅱ, aldosterone and cortisol at T2, T3, and T4 compared to TO in the parecoxib group （P〉0.05）, while the concentrations of plasma renin activity, angiotensin Ⅱ, aldosterone and cortisol at T2, T3 were significantly increased compared to T0 in the control group （P〈0.05）. The concentrations of plasma renin activity, angiotensin Ⅱ, aldosterone and cortisol at T2 and T3 were significantly lower in the parecoxib group than in the control group, with statistical difference between the two groups （P〈0.05）. Conclusion Parecoxib has a good postoperation analgesic effect, and can effectively prevent stress response. It is useful in relieving postoperative immunolesion and inflammatory reaction for breast cancer patients with radical excision of breast cancer.