加速康复外科策略中使用帕瑞昔布钠对胃癌根治术患者术后恢复的影响

Recovery impact of perioperative use of parecoxib in enhanced recovery after surgery strategy for patients undergoing curative gastric cancer

目的探讨加速康复外科(enhanced recovery after surgery,ERAS)策略中围术期使用帕瑞昔布钠对胃癌根治患者术后恢复的影响。方法选择2016年6月至2017年5月胃癌根治术患者60例,男40例,女20例,年龄18～65岁,BMI 18～30kg/m2,ASAⅠ—Ⅲ级。采用随机数字表法随机分为帕瑞昔布钠组(P组)和对照组(S组),每组30例。P组术前30min帕瑞昔布钠40mg+生理盐水稀释至5ml缓慢静推,术后每间隔12h静推帕瑞昔布钠40mg,连续使用3d;S组术前30min生理盐水5ml缓慢静推,术后每间隔12h静推生理盐水5ml,连续使用3d。两组围术期均采用ERAS策略,术后均给予舒芬太尼PCIA。记录两组患者术前(T0)、术后12h(T1)、24h(T2)和48h(T3)静息和咳嗽时VAS评分,术后24h内PCIA有效按压次数和舒芬太尼用量;检测术后2、5d炎性因子和癌胚抗原(CEA)浓度;记录术后排气时间、术后住院时间、术后切口感染、炎性肠梗阻和肺部感染等并发症的发生情况。结果 T1和T2时P组静息和咳嗽时VAS评分明显低于S组(P<0.05);术后24h内P组PCIA有效按压次数和舒芬太尼用量明显少于S组(P<0.05)。术后2dP组白介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)和C反应蛋白(CRP)浓度明显低于S组(P <0.05);术后5dP组IL-1β浓度、TNF-α浓度、中性粒细胞绝对数、前列腺素E2(PGE2)和CEA浓度明显低于S组(P<0.05)。P组术后排气时间和术后住院时间明显短于S组(P<0.05)。两组术后并发症发生率差异均无统计学意义。结论 ERAS策略中使用帕瑞昔布钠能有效减轻胃癌根治术患者术后疼痛和炎症反应,促进术后恢复和缩短术后住院时间,且不增加术后并发症风险。

Objective To investigate the recovery effect of perioperative use of parecoxib in enhanced recovery after surgery(ERAS)strategy for patients undergoing curative gastrectomy for cancer.Methods Sixty patients diagnosed as gastric cancer,40 males and 20 females,aged 18-65 years,BMI18-30 kg/m2,ASA physical statusⅠ-Ⅲ,were enrolled between June,2016 to May,2017.The patients were randomly allocated to experimental group(group P,n = 30)or control group(group S,n = 30).Patients in group P received parecoxib 40 mg dissolved in 5 ml saline iv.in 30 min before surgery and every12 hafter surgery for 3 d.Patients in group S received 5 ml saline instead of parecoxib before and after surgery.All patients received ERAS program perioperatively and PCIA postoperatively(sulfentanil).Rest and cough VAS score before surgery(T0)and at 12 h(T1),24 h(T2)and 48 h(T3)after surgery,effective PCIA pump compressions and sufentanil use within 24 hafter surgery were recorded.Inflammatory markers and serum CEA concentrations on postoperative day 2 and day 5 were measured;In addition,postoperative first flatus time,feeding time,hospital stay and postoperative complications like incisional infection,inflammatory bowel obstruction and pulmonary infection were recorded.Results Comparing to patients in group S,VAS score at rest and cough was significantly lower for patients in group P at T1 and T2(P < 0.05).Effective PCIA pump compressions and sufentanil use were significantly less in group P than group S within24 hafter surgery(P <0.05).In addition,serum concentrations of IL-1β,TNF-αand CRP were significantly lower in group P than in group S on postoperative day 2(P < 0.05).Number of neutrophiles and concentrations of serum IL-1β,TNF-α,PGE2 and CEA were lower in group P than in group S on postoperative day 5(P <0.05).Time of first flatus and postoperative hospital stay were shorter in group P than in group S(P < 0.05).The postoperative complication rate was comparable between the two groups.Conclusion Perioperative use of parecoxib after gastric surgery in ERAS program reduces postoperative pain and inflammatory reaction,enhances postoperative recovery and shortens postoperative hospital stay.Additionally,perioperative use of parecoxib dose not increase the risk of postoperative complications.