氟比洛芬酯对开胸患者术后镇痛效应及血浆细胞因子的影响

Influence of flurbiprofen axetil on postoperative analgesia effect and expression of serum cytokines after thoracotomy surgery

目的研究围术期静注氟比洛芬酯联合芬太尼术后自控静脉镇痛(PCIA)对开胸患者术后疼痛程度、血浆细胞因子释放和不良反应的影响。方法 50例开胸患者随机均分为2组,各25例。氟比洛芬酯组手术开始前30 min、切皮后6 h给氟比洛芬酯1 mg/kg,对照组术前30 min、切皮后6 h给相同容量的生理盐水。2组患者术后镇痛均采用PCIA,记录镇痛泵按压次数,术后2 h、6 h、24 h、48 h、72 h静息、咳嗽时VAS评分情况,以及药物不良反应发生情况。监测静注氟比洛芬酯前、术后24 h、48 h、72 h血浆IL-1β、IL-6、IL-8、IL-2、TNF-α含量。结果氟比洛芬酯组PCIA按压次数较对照组少,术后2 h、6 h、24 h、48 h静息、咳嗽时VAS评分均较对照组低(P<0.05或0.01)。2组的恶心、呕吐发生率比较均无显著性差异(P均>0.05)。2组患者术前与术后各时间点血浆IL-1β水平变化均无显著性差异(P均>0.05)。氟比洛芬酯组术后24 h、48 h血浆IL-6、TNF-α水平均较对照组低(P均<0.01),氟比洛芬酯组术后24 h血浆IL-8水平较对照组低(P<0.01)。氟比洛芬酯组血浆IL-2水平在术后24 h、48 h抑制程度较对照组均明显减轻(P均<0.01)。结论氟比洛芬酯联合术后静脉自控镇痛可改善开胸患者术后镇痛的质量,减少促炎症细胞因子的释放,减轻创伤引起的血浆IL-2的抑制,并且不增加不良反应的发生。

Objective It is to observe the influence of perioperative intravenous administration of flurbiprofen axetil combined with postoperative patient-controlled intravenous analgesia（PCIA） on postoperative pain,the side effects and the levels of serum cytokines after thoracotomy surgery.Methods 50 patients for thoracotomy were randomly divided into the FA group and the control group with 25 cases in each group.The FA group received FA 1 mg/kg for intravenous injection,30 min before and 6 hours after skin incision;and the control group received an equal volume of Normal saline.PCIA was executed in both groups.The VAS was used to assess pain intensity at 2 h,6 h,24 h,48 h and 72 h after the completion of surgery.The levels of IL-1β,IL-6,IL-8,IL-2 and TNF-α were determined before and at 24 h,48 h,and 72 h after the operation.The side effects were recorded.Results The pain scores were significantly different in both groups,the VAS scores in the FA group were lower than that in the control group（P〈0.05）.The incidences of side effects of two groups were not significantly different（P〉0.05）.The level of IL-1β were not significantly different between the two groups,but the levels of IL-6,TNF-α of the FA group was significantly lower than the control group at 24 h and 48 h（P all〈0.01）.The level of IL-8 of the FA group was significantly lower than that of the control group C at 24 h（P〈0.05）.The level of IL-2 of the FA group was significantly less suppressed than that of the control group at 24 h and 48 h（P〈0.05）.Conclusion Flurbiprofen axetil combined with PCIA can enhance the effect of postoperative analgesia,and attenuated the response of cytokine,clearly reduce immune-suppression,and don＇t increase side effect.