帕瑞昔布钠超前镇痛对腹腔镜胆囊切除术患者术后炎性因子及应激激素的影响

Effect of Preemptive Analgesia with Parecoxib Sodium on Postoperative Inflammatory Factors and Stress Hormone in Patients Undergoing Laparoscopic Cholecystectomy

目的观察帕瑞昔布钠超前镇痛对腹腔镜胆囊切除术患者术后炎性因子及应激激素的影响和术后镇痛效果。方法2010年3～9月60例择期拟行全麻下腹腔镜胆囊切除术的患者，按随机数字表随机分为2组，研究组（帕瑞昔布钠组）和对照组（生理盐水组），每组30例。2组患者分别在麻醉前30rain于静脉注射用生理盐水稀释成2ml的帕瑞昔布钠40rag或生理盐水2ml。分别在注射帕瑞昔布钠或生理盐水前10min（T1）、术后即刻（T2）、术后6h（T3）、12h（T4）、24h（T5）抽取静脉血样，测定血浆P物质、白细胞介素一6（IL．6）、肿瘤坏死因子（TNF一仪）的浓度以及血浆肾上腺素（E）、去甲肾上腺素（NE）水平。手术结束24h内采用视觉模拟评分法（VAS）评价术后1、2、4、6、8、12、24h的镇痛效果。结果研究组血P物质浓度在T2和T3时点显著低于对照组[T2：（101．66±8．16）pg／mlV8．（139．42±6．05）pg／ml，t：～20．360，P：0．000；T3：（119．51±10．13）pg／mlvs．（146．67±5．11）pg／ml，t=－13．111，P=0．000]。研究组血浆IL-6浓度在T2、T3、T4时点显著低于对照组[T2：（48．43±10．13）pg／mlvs．（67．41±12．03）Pg／ml，t=－6．610，P=0．000；T3：（61．87±12．31）pg／mlVS．（96．25±36．51）pg／ml，t=－4．887，P：0．000；T4：（42．35±11．18）pg／mlV8．（60．51±10．09）pg／ml，t=－6．605，P=0．000]。研究组血浆TNF一0【浓度在T2、T3、T4时点显著低于对照组（P〈0．05）。研究组血浆E和NE浓度在T2、T3时点均显著低于对照组（P〈0．05）。研究组术后1、2、4、6、8、12h静态和动态VAS评分显著低于对照组（P〈0．05）。结论腹腔镜胆囊切除术术前给予帕瑞昔布钠能产生良好的超前镇痛效应，减少炎性因子的产生，降低应激激素的释放，有利于术后恢复。

Objective To investigate the effects of parecoxib sodium preemptive analgesia on inflammatory factors and stress hormone and postoperative analgesia in patients undergoing laparoscopic choleeystectomy （ LC ）. Methods From March to September 2010, 60 ASA I-II patients undergoing laparoscopic cholecystectomy were randomly divided into 2 groups （ n = 30 in each） ： parecoxib group received intravenous parecoxib 40 mg/2 ml 30 minutes before anesthesia induction, and control group received normal saline 2 ml instead of parecoxib. Venous blood samples were obtained at 10 minutes before parecoxib or normal saline was injected （TI）, immediately when surgery was finished （T2）, and 6 hours （T3）, 12 hours （T4） and 24 hours （TS） after the surgery was finished, to determine the plasma levels of substance P, IL-6, and TNF-ct. At the same time, the plasma levels of epinephrine and norepinephrine at T1 - T5 were measured. VAS scores were recorded at 1, 2, 4, 6, 8, 12, and 24 hours after the surgery. Results Compared to the control group, the plasma levels of substance P decreased in the parecoxib group at T2 and T3 [ T2： （101.66±8.16） pg/mlvs. （139.42 ±6.05） pg/ml, t= -20. 360, P=O.000; T3：（119.51 -10.13） pg/ml vs. （146.67 -5.11） pg/ml, t = -13. 111, P =0.000]. The plasma levels of IL-6 decreased in the pareeoxib group at T2, T3, and T4 IT2：（48.43 - 10.13） pg/ml vs. （67.41 -12.03） pg/ml, t= -6.610, P=0.000; T3：（61.87 -12.31） pg/ml vs. （96.25 ±36.51） pg/ml, t= -4.887, P=0.000; T4：（42.35±11. 18） pg/ml vs. （60.51 - 10.09）pg/ml,t = -6.605,P =0.000]. The plasma levels of TNF-cxdecreased distinctly in the pareeoxib group at T2, T3, and T4 compared with the control group（P 〈 0.05）. And the plasma levels of epinephrine and norepinephrine decreased obviously in the parecoxib group at T2 and T3 （P 〈 O. 05 ）, VAS at both resting status and moving status had significant difference at 1, 2, 4, 6, 8 and 12 hours postoperatively in the pareeoxib group compared to the control group （P 〈0.05）. Conclusions Preemptive parecoxib can produce better analgesia effect, reduce the production of inflammatory factors, relieve stress responses and have a positive effect on postoperative recovery.