氟比洛芬酯超前镇痛对老年肿瘤患者术后镇痛及血浆细胞因子的影响

Effect of preemptive analgesia of flurbiprofen axetil on postoperative analgesia and plasma cytokines in senile patients with tumor

目的研究氟比洛芬酯超前镇痛对于老年肿瘤患者术后镇痛效果及围术期血浆细胞因子水平的影响。方法选择ASAI～Ⅱ级择期手术的老年肿瘤患者60例，随机分为2组，每组30例。采用双盲法分别于气管插管后（切皮前15min）静脉注射氟比洛芬酯5ml（A组）或脂肪乳剂5ml（B组），2组术后均辅以PCIA静脉镇痛泵，分别记录术后2、12、24h的镇痛评分（VAS值），不良反应及芬太尼用量。在麻醉开始前（TO）、手术2h（T1）、术毕（T2）及术后12h（r13）术后24h（T4）采取外周静脉血5ml用酶联免疫吸附法（ELISA）检测IL-6、IL一10、TNF—a和IFN一1水平。记录麻醉时间，术中出血量，手术输液量及瑞芬太尼和丙泊酚的用量。结果术后2、12hA组的VAS评分明显低于B组（P〈0．05），术后24h差异无统计学意义（P〉0．05）。PCA按压次数，芬太尼用量及不良反应A组低于B组，差异有统计学意义（P〈0．05）。与rID比较，2组T1，T2，T3时点血清TNF—a，IFN-1含量均明显升高（P〈0．05），且在Tl时点达高峰。与B组比较，A组T1，他，耶时点血清TNF—a含量降低（P〈0．05），IFN一1含量升高（P〈0．05）。与11D比较，2组T1，他，T3时点血清IL_6、IL一10含量均明显升高（P〈0．05），且在他时点达高峰。与B组比较，A组T1，T2，r乃时点血清IL_6含量降低，IL一10含量升高（P〈0．05）。2组患者四项指标在T4时点均接近恢复至术前水平（P〉0．05）。结论氟比洛芬酯超前镇痛对老年肿瘤患者术后镇痛效果确切，减少了芬太尼的用量，未增加不良反应的发生，并能降低老年肿瘤患者围手术期应激炎性反应。

Objective To investigate the effect of preemptive analgesia of flurbiprofen axetil on postoperative analgesia and plasma cytokines at peroperative period in senile patients with tumor. Methods 60 senile patients with tumor （ASA I ~ lI grade selective operation ） were randomly divided into two group, with 30 patients in each group. By means of double-blind method,after trachea eannula （15min before cutting skin） the patients in the two groups were given flurbiprofen axetil 5ml （group A） or fat emulsion （group B） 5ml by intravenous injection, respectively, with PCIA pump after operation. The analgesia scoring （VAS value） , adverse reaction and fentanyl dosage were recorded at 2h, 12h,24h after operation. The levels of IL-6, IL-10, TNF-aand IFN-3,in peripheral vein blood were detected by ELISA before anesthesia （ TO ）, 2h after operation （ T1 ）, operation end （ T2 ）, 12h after operation （ T3 ） and 24h after operation. The anesthesia time, perioperative bleeding volume, infusion volume and the dosage of remifentanil and propofol were recorded. Results The VAS scores ah, 12h after operation in group A were significantly lower than those in group B （ P 〈 0.05 ）, however, there were no significant differences 24h after operation between two groups （ P 〉 0.05 ）. PCA pressing number of times, fentanyl dosage and adverse reaction in group A were significantly lower than those in group B （ P 〈 0.05 ）. As compared with those at TO, the serum contents of TNF-a, IFN--y at T1, T2, T3 in both groups were obviously increased （ P 〈 0.05 ）, moreover, which reached peak at T1. As compared with those in group B, the serum levels of TNF-aat T1, T2,T3 in group A were significantly decreased （ P 〈 0.05 ）, however, the levels of IFN-~/were obviously increased （ P 〈 0.05 ）. As compared with those at TO,the serum levels of IL-6 ,IL-10 at T1 ,T2 ,T3 in both groups were significantly increased （ P 〈 0.05 ）, which reached peak at T2. As compared with those in group B, the serum levels of IL-6 at T1 ,T2,T3 in group A were significantly decreased, however, IL-10 contents were obviously increased （ P 〈 0.05 ）. The four parameters at T4 in both groups approached or recovered to the levels before operation （ P 〈 0.05 ）. Conclusion The effect of preemptive analgesia of flurbiprofen axetil is definite on postoperative analgesia in senile patients with tumor, which can reduce fentanyl dosage,without increasing the incidence of adverse reaction, which can also decrease stress inflammatory reaction at peroperative period in senile patients with tumor.