氟比洛芬酯预先给药对腹部手术时肠系膜牵拉综合征的影响

目的探讨氟比洛芬酯预先给药对腹部手术时肠系膜牵拉综合征的影响。方法择期全身麻醉下行开腹胃肠道手术患者60例,年龄42~83岁,ASAⅠ级或Ⅱ级。采用随机数字表法分为氟比洛芬酯组(F组)和对照组帕瑞昔布钠组(P组),各30例。F组麻醉诱导时静脉注射氟比洛芬酯40mg,P组则静脉注射帕瑞昔布钠40mg。分别于麻醉诱导时(T0)、牵拉肠系膜即刻(T1)、牵拉肠系膜后10min(T2)、15min(T3)和30min(T4)时监测血流动力学参数,采用ELISA法检测血浆6-keto-PGF1α浓度并记录牵拉肠系膜后30min内肠系膜牵拉综合征的发生情况。结果F组和P组在T0时和T1时各血流动力学参数和血浆6-keto-PGF1α比较差异无统计学意义(P>0.05);与F组比较,P组在T2时SBP、DBP和MAP下降,HR增高(P<0.05);在T3时仅HR增高(P<0.05);T4时各血流动力学参数比较差异无统计学意义(P>0.05);在T2~T4时血浆6-keto-PGF1α浓度增加(P<0.05)。根据改良的肠系膜牵拉综合征Koyama’s分级与F组比较,P组在T1~T2、T2~T3和T3~T4时间段内肠系膜牵拉综合征发生率高(P<0.01)。结论在胃肠道手术时,麻醉诱导时氟比洛芬酯预先给药可以预防或减轻肠系膜牵拉综合征的发生。

Objective To investigate the effects of flurbiprofen axetil pretreatment on mesenteric traction syndrome undergoing abdominal surgery.Methods Sixty patients aged 42~83yr,ASAⅠorⅡscheduled for elective gastrointestinal tract surgery under general anesthesia with trachea cannula,were randomly and equally divided into two group using a random number table:flurbiprofen axetil group(group F)and parecoxib sodium group(group P).Flurbiprofen axeti 40mg was intravenously injected during anesthesia induction in group F,and the sane dose of parecoxib sodium was given in group P.Arterial blood pressure and heart rate were recorded,and the plasma 6-keto-PGF1αconcentrations using enzyme-linked immunosorbent assay were measured in anesthesia induction,immediately after mesenteric traction and at 10,15 and 30min after mesenteric traction(T0,T1,T2,T3,T4)to confirm the diagnosis of MTS.Results At T0 and T1,no significant changes were found in the hemodynamic parameters and the mean plasma 6-keto-PGF1αconcentration in group F and group P(P>0.05).Compared with group F,the group P patients showed significantly lower SBP,DBP,MAP and a faster heart rate was significantly elevated at T2(P<0.05);but at T3,the group P patients only showed significantly faster heart rate(P<0.05);no significant changes were found in the hemodynamic parameters at T4(P>0.05);at T2~4 the mean plasma 6-keto-PGF1αconcentration was dramatically elevated in group P(P<0.05).Compared with group F,according to modified Koyama’s classification of mesenteric traction syndrome,at T2~4 mesenteric traction syndrome had a high incidence in group P(P<0.01).Conclusion Flurbiprofen axetil pretreatment can prevent or mitigate mesenteric traction syndrome in anesthesia induction undergoing gastrointestinal tract surgery.