探讨氟比洛芬酯应用于宫颈癌手术术后镇痛的临床效果

Clinical effect of flurbiprofen axetil in the postoperative analgesia of cervical cancer surgery

目的探讨氟比洛芬酯应用于宫颈癌手术术后的镇痛效果以及对免疫因子的影响。方法于2016年1月—2017年6月,选择大连大学附属中山医院择期在腹腔镜下行宫颈癌根治术的病人90例,连续入组,根据术后镇痛用药分为氟比洛芬酯组、舒芬太尼组和芬太尼组。观察术后不同时间点的评估视觉模拟量表(VAS)疼痛评估、不良反应;测定入室时、术后12 h、24 h和48h的血清中的CD4、CD8、IL-1、IL-6CD4/CD8的比值和PGEs的水平。结果术后12 h和24 h的VAS评分氟比洛芬酯组显著低于舒芬太尼组和芬太尼组,(P<0.05);免疫因子方面,三组血清中的CD4、CD8、IL-1、IL-6、CD4/CD8的比值和PGEs的水平,无统计学差异(P>0.05);各组术后2 h、12 h、24 h,IL-1和IL-6含量显著高于入室时的含量(P<0.05);在2 h、12 h、24 h时间点上IL-1和IL-6含量芬太尼组显著高于氟比洛芬酯组和舒芬太尼组(P<0.05)。与入室时对比,三组病人CD4/CD8比值在术后均下降,其舒芬太尼组和芬太尼组在24 h时下降明显(P>0.05);在24 h时的CD4/CD8比值芬太尼组明显低于舒芬太尼组(P<0.05);与入室时相比2 h、12 h和24 h的PGE2含量,三组患者均上升,舒芬太尼组和芬太尼组在12 h点上升明显(P<0.05)。结论氟比洛芬酯联合舒芬太尼应用到腹腔镜下行宫颈癌术后镇痛效果提高,同时减轻术后不良反应,并且有较好地减少炎性介质的分泌,并且对细胞免疫功能影响轻微。

Objective The objective of this study was to investigate the analgesic effect of flurbiprofen axetil and its effect on immune factors after cervical cancer surgery. Methods Ninety patients with cervical cancer undergoing laparoscopic surgery were randomly divided into three groups with 30 patients in each group in Zhongshan Hospital Affiliated to Dalian University from January 2016 to June 2017. The indexes of assessment were visual assessment of visual analog scale（ VAS） pain assessment and postoperative adverse reaction at 2,12,24 and 48 h after operation. The levels of CD4,CD8,IL-1,IL-6,CD4/CD8 and PGEs in the serum at 12,24 and 48 h after operation were measured. Results The VAS scores in the A group were significantly lower than those in the B and C groups during 12 and 24 h after operation（ P〈0. 05）. But there were no significant differences in the levels of CD4,CD8,IL-1,IL-6,CD4/CD8 and PGEs amongst the three groups（ P〈0. 05）. The levels of IL-1 and IL-6 at 2,12 and 24 h after operation were significantly higher than those in the baseline（ P〈0. 05）. However,the levels of IL-1 and IL-6 in the C group was significantly higher than those in the A and B groups（ P〈0. 05）. Compared to before operation,the ratio of CD4/CD8 was decreased and the level of PGE2 was increased in the three groups after operation. After 24 h operation,the ratio of CD4/CD8 in the B group were significantly lower than that in the C group（ P〈0. 05）. The level of PGE2 at 12 h after operation was significantly increased in the B and C groups（ P〈0. 05）. Conclusion The combination of flurbiprofen axetil and sufentanil in the laparoscopic surgery of cervical cancer can improve postoperative analgesia and reduce adverse reactions,effectively reduce the secretion of inflammatory mediators and minor affect on cellular immune function.