帕瑞昔布钠超前镇痛对子宫肌瘤患者术后镇痛效果及细胞免疫功能的影响

Effect of Parecoxib Sodium Preemptive Analgesia on Postoperative Analgesia and Cellular Immune Function in Patients with Uterine Fibroids

目的探讨帕瑞昔布钠超前镇痛对子宫肌瘤患者术后镇痛效果以及细胞免疫功能的影响。方法选取2011年3月至2014年4月择期行子宫肌瘤切除术患者116例,随机分为超前组(n=58)和对照组(n=58),麻醉前30min,超前组采用40mg帕瑞昔布钠进行静脉注射,对照组采用5mL生理盐水进行静脉注射。利用视觉模拟评分法(VAS法)对两组患者术后疼痛情况进行评价,记录两组患者PCIA泵首次触发时间、有效按压次数和芬太尼总量。分别于术前(T0)、术后6h(T1)、24h(T2)、48h(T3)和72h(T4)采集患者静脉血,采用FACS Calibur流式细胞仪检测T淋巴细胞亚群CD3+、CD4+和CD8+以及NK细胞,计算CD4+/CD8+。结果术后4、8、12、24和48h,超前组患者疼痛评分均低于对照组,差异均具有统计学意义(均P<0.05);超前组患者PCIA首次触发时间晚于对照组,有效按压次数和芬太尼总量均少于对照组(均P<0.05)。T1、T2和T3时点,超前组CD3+与CD4+细胞比例均高于对照组(均P<0.05);T1和T2时点,超前组CD4+/CD8+均高于对照组(均P<0.05);T2和T3时点,超前组NK细胞比例均高于对照组(均P<0.05)。结论帕瑞昔布钠超前镇痛应用于子宫肌瘤患者能够减轻患者术后疼痛,减少镇痛药用量,减轻免疫抑制,改善患者术后细胞免疫功能。

Objective To investigate effects of parecoxib sodium preemptive analgesia on postoperative analgesia and cellu‐lar immune function in patients with uterine fibroids.Methods Totally ,116 cases of patients receiving uterine fibroids surgery were selected from March 2011 to April 2014 in our hospital.All cases were randomly divided into advanced group（n=58）and control group（n=58）. The cases in the advanced group were intravenously injected with parecoxib sodium（40 mg）30 min before anesthesia ,while the control group received 5 mL saline intravenously.Postoperative pain conditions of the two groups were e‐valuated by using visual analog scale（VAS method）. The PCIA pump first trigger time ,effective compression number and the total amount of fentanyl were recorded. Venous blood was collected before operation ,6 h（T1 ） ,24 h（T2 ） ,48 h（T3 ）and 72 h（T4 ） after operation ,respectively. T lymphocyte subsets of CD3＋ ,CD4＋ and CD8＋ and NK cells were detected by using FACS Cali‐bur flow cytometer.The ratio of CD4＋ /CD8＋ was calculated.Results After 4 ,8 ,12 ,24 and 48 h ,the pain scores of patients were significantly lower in the advanced group than in the control group（all P〈0.05）. The PCIA pump first trigger time was longer ,effective compression number and the total amount of fentanyl of patients were less in the advanced group than in the control group ,the differences were statistically significant（all P〈0.05）. At T1 ,T2 and T3 ,CD3＋ and CD4＋ were significantly higher in the advanced group than in the control group（P〈0.05）.At T1 and T2 ,CD4＋ /CD8＋ was significantly higher in the advanced group than in the control group（both P〈0.05）.At T2 and T3 ,the NK was significantly higher in the advanced group than in the control group（both P〈0.05）.Conclusion Parecoxib sodium preemptive analgesia used in patients with uterine fi‐broids can reduce postoperative pain ,reduce the amount of analgesics ,reduce the immune suppression ,and improve immune function in patients after surgery.