帕瑞昔布钠对甲状腺切除术患者的镇痛疗效和炎性细胞因子影响的研究

Study of the Analgesic Efficacy and Effects on Inflammatory Cytokines of Parecoxib Sodium in Patients Undergoing Thyroidectomy

目的研究帕瑞昔布钠术后镇痛应用于甲状腺切除术的疗效和对炎性细胞因子IL-6和TNF-α的影响。方法甲状腺切除术患者60例随机分成两组,P组(帕瑞昔布钠组)和C组(空白对照组),予气管插管全麻。P组在麻醉诱导前给予静脉注射帕瑞昔布钠40 mg,C组在麻醉诱导前给予等量生理盐水5 mL。观察指标:测定术前、术毕和术后6 h、12 h、24 h的血浆炎性细胞因子IL-6和TNF-α水平;记录VAS疼痛评分;记录血压,心率等生命体征和不良反应。结果两组均是术毕及术后各时间点的IL-6和TNF-α水平高于术前的水平(P<0.05);P组术毕及术后各时间点的IL-6和TNF-α水平均低于C组(P<0.05)。P组术后各时间点VAS疼痛评分低于C组(P<0.05)。血压及心率在术后各时间点P组均低于C组(P<0.01);P组除了拔管后5 min的血压及心率高于术前基础值,其余术后各时间点与术前基础比较无明显差别(P>0.05);C组术后各时间点的血压及心率均比术前升高(P<0.01)。P组拔管时躁动呛咳率低于C组(P<0.01),两组的恶心呕吐、头晕嗜睡和呼吸抑制的发生率无明显差别(P>0.05)。结论帕瑞昔布钠对甲状腺切除术患者能起到有效的镇痛作用,抑制炎性细胞因子的释放,减少免疫损伤,并使患者的血流动力学更平稳。

Objective To study the analgesic efficacy and effects of parecoxib sodium on inflammatory cytokines IL-6 and TNF-α levels in patients undergoing thyroidectomy. Methods 60 patients undergoning thyroidectomy were randomly divided into two groups： Group P （parecoxib sodium group） and Group C （control group）. Patients of the two groups were performed endotracheal intubation and intravenous anesthesia. Group P received intravenous injection ofparecoxib sodium 40 mg before anesthesia induction, Group C was given normal saline 5 mL before anesthesia induction. Serum IL-6 and TNF-ct levels were measured before the operation, at the end of the operation and at the time of 6 h, 12 h, 24 h after the operation. Blood pressure （BP）, heart rate, VAS pain scores and adverse reactions were recorded. Results The IL-6 and TNF-ct levels of both groups at each time point after operation were significantly higher than those before operation （P 〈0.05）. IL-6 and TNF-c~ levels, VAS pain score, BP and heart rate of Group P were significantly lower than those of Group C at each time point after the operation （P 〈0.05）. The BP and heart rate of Group P at each time point after the operation were similar to the preoperative ones except for the BP and heart rate 5 min after extubation. The BP and heart rate of Group P at each time point after the operation were significantly higher than those before the operation （P 〈0.01）. The bucking rate of Group P was significantly lower than that of Group C during extubation （P 〈0.01）. The incidence of nausea, vomiting, lethargy and respiratory inhibition between the two groups had no significant difference （P 〉0.05）. Conclusions Parecoxib sodium has great analgesic efficacy. It can inhibit the release of inflammatory cytokines, reduce the injury to the immunity and stablize the hemodynamics.