帕瑞昔布钠超前镇痛对下肢缺血—再灌注患者炎性因子的影响

EFFECTS OF PREEMPTIVE ANALGESIA WITH PARECOXIB SODIUM ON INFLAMMATORY FACTORS IN PATIENTS UNDERGOING ISCHEMIA-REPERFUSION OF LOWER EXTREMITY

目的:观察帕瑞昔布钠超前镇痛对下肢缺血-再灌注(ischemia-reperfusion,I-R)患者围术期白细胞介素-6(interleukin-6,IL-6)、白细胞介素-8(interleukin-8,IL-8)、肿瘤坏死因子-α(tumor necro-sis factor-α,TNF-α)的影响。方法:将40例单侧膝关节手术患者随机分为帕瑞昔布钠组(P组,n=20)和对照组(C组,n=20)。均采用连续硬膜外麻醉。P组患者于上止血带前10 min静注帕瑞昔布钠40 mg+生理盐水2 ml,C组患者给予生理盐水2 ml。分别于两组患者上止血带前(T1)、手术结束时(T2)、术后6小时(T3)、术后12小时(T4)、术后24小时(T5)抽取静脉血样,测定血浆IL-6、IL-8、TNF-α浓度。结果:与T1时比较,C组在T2、T3、T4时IL-6浓度升高(P<0.05),T3、T4时IL-8浓度升高(P<0.05),T3时TNF浓度升高(P<0.05)。P组在T3时IL-6浓度升高(P<0.05),T4时IL-8浓度升高(P<0.05)。与C组比较,P组在T3时的血浆IL-6浓度和T4时的IL-8浓度显著降低(P<0.05),血浆TNF-α的浓度无明显变化(P>0.05)。结论:帕瑞昔布钠超前镇痛可有效抑制I-R患者围术期炎细胞因子产生。

Objective： To investigate the effects of preemptive analgesia with parecoxib sodium on interleu- kin-6 （IL-6）, interleukin-8 （IL-8） and tumor necrosis factor-α （TNF-α） in patients undergoing ischemia- reperfusion （I-R） of lower extremity. Methods： Forty patients scheduled for operation on unilateral knee joint were randomly divided into parecoxib group （group P, n = 20） and control group （group C, n = 20）. All patients received continuous epidural anesthesia. Group P received intravenous parecoxib 40 mg and normal saline 2 ml at 10 min before deflation of the tourniquet, and group C received intravenous normal saline 2 ml. Venous blood samples were taken before deflation of the tourniquet （T1）, at the end of operation （ T2 ） , at 6 h （ T3 ）, 12 h （ T4 ） and 24 h （ T5 ） after operation for determination of serum IL-6, IL-8 and TNF-a concentrations. Results： Compared with T1, serum IL-6 was significantly higher at T2, T3 and T4, serum IL-8 was significa-ntly higher at T3 and T4, and serum TNF-a was significantly higher at T3 （P 〈 0.05） in group C. Serum IL-6 was significantly higher at T3 and serum IL-8 was significantly higher at T4 （P 〈 0.05） in group P. Compared with group C, serum IL-6 was significantly lower at T3 and serum IL-8 was significantly lower at T4 in group P （P 〈 0.05）. There were no significant difference in serum TNF-α between group P and C （P 〉 0.05）. Conclusion： Preemptive analgesia with parecoxib sodium can efficiently suppress production of inflammatory factors in patients undergoing I-R of lower extremity.