环氧化酶-2抑制剂对功能性鼻内镜手术后血浆及术野渗液前列腺素E_2的作用

Effect of cycloxygenase 2 inhibitor on levels of prostaglandin E_2 in plasma and in local infiltrated fluid after functional endoscopic sinus surgery

目的:外科手术引起的炎性反应会影响患者预后,本随机对照研究拟检验功能性鼻内镜手术后术野渗液和血浆前列腺素E2(prostaglandin E2,PGE2)的变化以及与疼痛及预后的相关性。方法:37名准备在全身麻醉下行功能性鼻内镜手术的患者被随机分为两组,塞来昔布组(n=16)术前1 h口服塞来昔布400 mg,术后连续5 d口服塞来昔布200 mg,q12 h;对照组(n=21)不服药。术后即刻到术后48 h收集鼻腔术野渗液并采集静脉血测量PGE2浓度,同时测量血浆中血栓烷素A2(thromboxane A2,TXA2)和前列环素(prostacyclin,PGI2)的浓度。结果:功能性鼻内镜手术后,对照组术野渗液和血浆PGE2水平显著升高,分别在术后6 h(177.5±142.2 ng/L)和48 h(64.5±21.4 ng/L)达到高峰。塞来昔布组出现术野渗液PGE2水平(术后6 h达到高峰,106.2±33.4 ng/L)和血浆PGE2水平(术后48 h达到高峰,44.7±30.2 ng/L)显著下降(P<0.05)。术后疼痛视觉模拟评分(VAS)与术野渗液的PGE2水平呈正相关,术后6 h和48 h相关系数分别为0.333(P=0.044)和0.353(P=0.032)。塞来昔布对TXA2/PGI2比值无影响。结论:外科手术部位PGE2水平升高是手术后炎症反应的重要表现,并参与引起术后疼痛;环氧化酶-2抑制剂可以显著抑制外周和血浆PGE2水平。

Objective： To examine the time course and clinical relevance of changes in prostaglandin E2（PGE2） to pain and outcome in surgical drainage,and circulating blood after functional endoscopic sinus surgery（FESS）.Methods： Thirty-seven patients scheduled to undergo FESS were randomized to receive celecoxib 400 mg（n=16） one hour before anesthesia induction and celecoxib 200 mg,q12 h for five consecutive days after surgery or nothing for patients in control group（n=21）.Surgical site drainage and venous blood were collected up to 48 hours after surgery to test PGE2 level.Plasma levels of thromboxane A2（TXA2） and prostacyclin（PGI2） were also tested for the same time course.Results： For control patients,PGE2 level was elevated in both surgical site and circulating blood,which reached a peak concentration 6 h（177.5±142.2 ng/L） and 48 h（64.5±21.4 ng/L）respectively after FESS.For patients in celecoxib group,a significant reduction of surgical drainage PGE2（peak level 106.2±33.4 ng/L at 6 h） and plasma PGE2（peak level 44.7±30.2 ng/L at 48 h）was observed（P〈0.05）.Pain scores 6 h and 48 h after surgery were positively correlated with surgical drainage PGE2 level,correlation coefficient being 0.333（P=0.044）and 0.353（P=0.032）respectively.Celecoxib did not affect the ratio of plasma TXA2 to PGI2.Conclusion： Upregulation of PGE2 in surgical site after surgery was crucial in inflammatory response and postoperative pain.Cycloxygenase-2 inhibitor could significantly reduce surgical drainage and plasma PGE2 concentration.