帕瑞昔布钠预先给药对腹腔镜直肠癌根治术患者肺功能的影响

Effects of parecoxib sodium premedication on pulmonary function in patients with rectal cancer undergoing laparoscopic eradication

目的:探讨帕瑞昔布钠预先用药对腹腔镜直肠癌根治术患者肺功能的影响。方法:选择择期腹腔镜下行直肠癌根治术的患者60例,年龄48～67岁,体重52～68 kg,ASA分级Ⅰ级或Ⅱ级,随机分为2组(n=30):对照组(C组)和帕瑞昔布钠组(P组)。均采用全麻复合硬膜外阻滞。硬膜外穿刺置管后全麻诱导前,P组静脉注射帕瑞昔布钠40 mg(生理盐水稀释至5 mL),C组给予等容量生理盐水。分别于预注药前即刻(T0)、气腹后1 h(T1)、关气腹前即刻(T2)、术后4 h(T3)、术后24 h(T4)采集外周静脉血3 mL,测定血清IL-6、IL-10和TNF-α浓度,同时行动脉血气分析,计算呼吸指数(RI)和PaO2/Fi O2。结果:与T0时比较,C组T1～4时血清TNF-α、IL-6浓度升高,T1～3时血清IL-10浓度升高(P<0.05);P组T1～3时血清TNF-α、IL-6浓度升高,T1～4时血清IL-10浓度升高(P<0.05),两组T1～2时RI升高,PaO2/Fi O2降低(P<0.05)。与C组比较,T1～4时P组血清TNF-α、IL-6浓度降低,血清IL-10浓度升高(P<0.05),T1～2时P组RI降低,PaO2/Fi O2升高(P<0.05)。结论:帕瑞昔布钠预先给药可通过减轻全身炎性反应而对腹腔镜直肠癌根治术患者的肺功能起到保护效应。

AIM ： To investigate the effect of parecoxib sodium premedication on pulmonary function in patients with rectal cancer undergoing laparoscopic eradication. METHODS ： Sixty ASA Ⅱ or Ⅱpatients with rectal cancer,aged 48-67 year and weighing 52-68 kg undergoing laparoscopic eradication were randomly divided into 2 groups（n=30 each）：control group（group C） and parecoxib sodium group（group P）.General anesthesia combined epidural blockade were performed in all eligible patients.Parecoxib sodium 40 mg（diluted to 5 mL with normal saline）was injected via vein route before anesthesia induction in group P,while in group C normal saline 5 mL was intravenously administered.Serum IL-6,IL-10 and TNF-α were assayed and arterial blood gas analysis were measured in the following time points： pre-induction（T 0）,1 h after pneumoperitoneum（T 1）,termination of pneumoperitoneum（T 2）,postoperative 4 h（T 3）and 24 h（T 4）.Respiratory index（RI） and PaO 2/FiO 2 were calculated. RESULTS ：Compared with the baseline values at T 0,serum TNF-α and IL-6 concentrations at T 1-4 and serum IL-10 concentration at T 1-3 were significantly increased in group C,while in group P serum TNF-α and IL-6 concentrations at T 1-3 and serum IL-10 concentration at T 1-4 were significantly increased（P 0.05）.RI was significantly increased and PaO 2/FiO 2 was significantly descended at T 1-2 in two groups（P 0.05）.Serum TNF-α and IL-6 concentrations at T 1-4 and RI at T 1-2 were significantly lower while serum IL-10 concentration at T 1-4 and PaO 2/FiO 2 at T 1-2 were significantly higher in group P than those in group C（P 0.05）. CONCLUSION ： Parecoxib sodium premedication can effectively protect the pulmonary function in patients with rectal cancer undergoing laparoscopic eradication by attenuating systemic inflammatory response.