氟比洛芬酯预给药对小儿扁桃体摘除术后镇痛及其对炎症因子表达的影响

Influence of preadminstration of flurbiprofen axetil on postoperative analgetic efficacy and inflammatory cytokine expression of children undergoing tonsillectomy

目的 观察氟比洛芬酯预给药在小儿扁桃体摘除术后镇痛的效果及其对术后IL-6、IL-10、TNF-α表达的影响.方法 选取择期行扁桃体摘除术的患儿90例,ASA Ⅰ～Ⅱ级,随机将其分为三组,每组30例,Ⅰ组为预给药组,于手术前30 min单次应用氟比洛芬酯1 mg/kg;Ⅱ组为术后给药组,于手术结束时单次应用氟比洛芬酯1 mg/kg;Ⅲ组为空白对照组,给予生理盐水5 ml.观察术前、术后1h、2h、4h、8h、12h、24 h VAS疼痛评分和OPS评分.分别于麻醉诱导前、切皮后6h、12h、24 h抽取外周静脉血2ml,离心后取血浆,测定IL-6、IL-10、TNF-α浓度.结果 与Ⅲ组比较,Ⅰ组、Ⅱ组术后各时点VAS疼痛评分、OPS评分均降低；与Ⅱ组比较,I组术后各时点VAS疼痛评分较低,I组术后4h、8h、12 h、24 h OPS评分较低低.与术前比较,Ⅰ组、Ⅱ组IL-10、TNF-α于术后6h升高,术后12h达到峰值,术后48 h恢复到术前水平,而IL-6 Ⅰ组仅于术后12h显著高于术前,Ⅱ组术后12h、24 h显著高于术前（P＜0.05）；与Ⅲ组比较,IL-10、TNF-α Ⅰ组和Ⅱ组于术后6h、12h、24 h显著低于Ⅲ组（P＜0.05）,IL-6 Ⅰ组于术后12h显著低于Ⅲ组,Ⅱ组术后12 h、24 h显著低于Ⅲ组（P＜0.05）；与Ⅱ组比较,Ⅰ组IL-10、TNF-α于术后6h、12h、24 h均显著低于Ⅱ组,IL-6术后12h显著低于Ⅱ组（P＜0.05）.结论 术前或术后给予氟比洛芬酯用于小儿扁桃体摘除术能有效的抑制炎症反应,镇痛效果确切,并且预给药明显优于术后给药.

Objective To evaluate the influence of the preadministration of flurbiprofen axetil on the postoperative analgetic efficacy and inflammatory cytokine expression in children undergoing tonsillectomy.Methods 90 patients,ASA Ⅰ ～ Ⅱ,undergoing tonsillectomy were randomly divided into a preemptive analgesia group （group Ⅰ）,a postoperative analgesia group （group Ⅱ）,and a control group （group Ⅲ）,30 patients for each group.Group Ⅰ singly administrated flurbiprofen axetil 1 mg/kg 30 minutes before the surgery; group Ⅱ administrated flurbiprofen axetil 1 mg/kg at the end of the surgery; group Ⅲ took normal saline 5 ml.VAS pain score and OPS score were recorded before and 1 h,2 h,4 h,8 h,12 h,and 24 h after the surgery.2 ml peripheral venous blood was collected before the induction of anesthesia and 6 h,12 h,and 24 h after skin incision.The plasma was obtained and stored for determining the concentrations of IL-6,IL-10,and TNF-α.Results VAS pain score and OPS score were lower in group Ⅰ and group Ⅱ than in group Ⅲ at each time point after the surgery （P ＜ 0.05）.Compared with group Ⅱ,VAS pain score decreased at each time point after the operation in group Ⅰ,while OPS score reduced at 4 h,8 h,12 h,and 24 h after the surgery in group Ⅰ （P ＜ 0.05）.Comparing with that before the surgery,TNF-α and IL-10 in group Ⅰ and group Ⅱ increased from 6 h after surgery and reached the peak 12 h after the surgery,then returned to the level before the surgery 48 h after the surgery,while IL-6 diminutively increased only 12 h after the surgery in group Ⅰ and 12 h,24 h after the surgery in group Ⅱ （P ＜ 0.05）.Compared with group Ⅲ,IL-10 and TNF-α markedly decreased 6 h,12 h,and 24 h after the surgery in group Ⅰ and group,and IL-6 markedly decreased 12 h after the surgery in group Ⅰ and 12 h and 24 h after the surgery in group Ⅱ （P ＜ 0.05）.Compared with group Ⅱ,IL-10 and TNF-α markedly lowered 6 h,12 h,and 24 h after the surgery in group Ⅰ,and IL-6 markedly decreased 12 h after the surgery in group Ⅰ （P ＜ 0.05）.Conclusions Preoperatively or postoperatively administrating flurbiprofen axetil for pediatric tonsillectomy can effectively inhibit inflammation and provide effective analgesia.However,preadministration is far better than postoperative administration.