氟比洛芬酯联合舒芬太尼PCIA对乳腺癌根治术后炎症介质的表达及细胞免疫功能的影响

Effects of flurbiprofen axetil combined with sufentanil PCIA on the expression of inflammatory mediators and cellular immune function after radical mastectomy

目的:分析氟比洛芬酯联合舒芬太尼静脉自控镇痛(PCIA)对乳腺癌根治术后炎症介质的表达及细胞免疫功能的影响,为患者术后镇痛提供指导。方法:选取2017年4月~2019年11月择期行乳腺癌根治术患者86例作为研究对象。采用随机数表法,分观察组和对照组,各43例。对照组采用舒芬太尼镇痛,观察组采用氟比洛芬酯联合舒芬太尼痛PCIA。比较两组不同时间点视觉模拟疼痛评分(VAS)评分、白细胞介素-2(IL-2)、白细胞介素-8(IL-8)、白细胞介素-10(IL-10)、T细胞亚群及自然杀伤细胞(NK)水平变化,记录泵按压次数、泵消耗总量及不良反应状况。结果:术后12h、24h、48h,患者VAS评分均降低,且观察组明显低于对照组,差异有统计学意义。术后24h、48h,观察组患者的IL-2、IL-8均低于对照组;而IL-10水平升高,观察组高于对照组,差异有统计学意义;术后48h,对照组患者的IL-2、IL-8、IL-10水平接近术前,差异无统计学意义;观察组IL-2、IL-8水平明显低于术前,IL-10水平明显高于术前,差异有统计学意义。术后24h观察组患者的CD4^(+)、CD4^(+)/CD8^(+)、NK细胞水平低于对照组,而CD8^(+)水平明显升高,且观察组高于对照组,差异有统计学意义;术后48h,观察组T细胞亚群、NK细胞水平接近术前,差异无统计学意义;而对照组CD4^(+)、CD4^(+)/CD8^(+)、NK细胞水平明显低于术前,CD8^(+)水平明显高于术前,差异有统计学意义。观察组泵按压次数、泵总消耗量均水平低于对照组,差异有统计学意义。观察组不良反应发生率为9.30%%,明显低于对照组的25.58%,差异有统计学意义。结论:氟比洛芬酯联合舒芬太尼PCIA应用于乳腺癌根治术后,可明显降低患者术后疼痛,调节T细胞亚群、NK细胞水平和炎症介质水平,减少术后镇痛药物使用量,降低不良反应,效果优于舒芬太尼,值得临床推广使用。

Objective To investigate the effect of flurbiprofen axetil combined with sufentanil on the expression of inflammatory mediators and cellular immune function in patients with breast cancer after radical operation.Methods 86 patients who underwent radical mastectomy from April 2017 to November 2019 were selected as the study objects.The patients were divided into observation group and control group,43 cases each.Sufentanil was used in the control group and flurbiprofen axetil combined with sufentanil in the observation group.The visual analogue pain score (VAS),interleukin-2(IL-2),interleukin-8(IL-8),interleukin-10(IL-10),T cell subsets and natural killer cell (NK) changes were compared between the two groups at different time points after operation.The number of pump presses,total pump consumption and adverse reactions were recorded.Result The level of IL-2 and IL-8 in the observation group was lower than that in the control group,while the level of IL-10 in the observation group was higher than that in the control group;the level of IL-2,IL-8 and IL-10 in the control group was close to that before operation at 48 hours after operation,and the level of IL-2 and IL-8 in the observation group was significantly lower than that before operation The difference was statistically significant.The level of IL-2 and IL-8 in the observation group was lower than that in the control group,while the level of IL-10 in the observation group was higher than that in the control group;the level of IL-2,IL-8 and IL-10 in the control group was close to that before operation at 48 hours after operation,and the level of IL-2 and IL-8 in the observation group was significantly lower than that before operation.The difference was statistically significant.The times of pump pressing and the total consumption of pump in the observation group were lower than those in the control group.The incidence of adverse reactions in the observation group was 9.30%,which was significantly lower than that in the control group (25.58%).Result At 12,24 and 48 hours after the operation,the VAS scores of the patients in the observation group were significantly lower than those in the control group.The levels of CD4 +,CD4 + / CD8 +,NK cells in the observation group were significantly lower than those in the control group,while the levels of CD8 + in the observation group were significantly higher than those in the control group;48 hours after the operation,the level of T-cell subsets and NK cells in the observation group was close to that before the operation,with no significant difference;while the levels of CD4 +,CD4 + / CD8 +,NK cells in the control group were significantly lower than those in the observation group.The difference was statistically significant.Conclusion Flurbiprofen axetil combined with sufentanil PCIA after radical mastectomy can reduce postoperative pain,regulate T cell subsets,NK cell levels and inflammatory mediators concentration,reduce the use of postoperative analgesic drugs,reduce adverse reactions,and the effect is better than sufentanil,which is worthy of clinical application.