帕瑞昔布钠对乳腺癌改良根治术患者炎症因子及免疫功能的影响研究

Effect of Parecoxib sodium on inflammatory factors and immune function in patients undergoing modified radical mastectomy

为探讨帕瑞昔布钠对乳腺癌改良根治术患者术后疼痛、炎症因子、免疫功能的影响,文章选择乳腺癌改良根治术患者80例,按照随机数字表法分成帕瑞昔布钠组(A组)和对照组(B组),每组各40例。在麻醉诱导前15 min,A组患者静脉注射帕瑞昔布钠40 mg,B组患者静脉注射生理盐水5 mL。术后两组患者均给予舒芬太尼镇痛泵行自控镇痛(PCIA)。于麻醉诱导前、手术结束后2 h、手术结束后4 h、手术结束后24 h各时点采集两组患者静脉血2 mL,采用酶联免疫吸附法(ELISA)检测血浆IL-6,TNF-α,COR,AT-II水平,采用流式细胞术检测T淋巴细胞亚群(CD3^(+),CD4^(+),CD8^(+))及自然杀伤细胞(natural killer cell,NK)(CD3-,CD16^(+),CD56^(+))的百分比,并记录术后2 h,4 h,24 h,48 h两组患者疼痛视觉模拟评分(VAS),以及48 h内自控镇痛按压次数。结果显示:术前两组患者的VAS评分、T淋巴细胞亚群及NK细胞分布比例、血浆IL-6,TNF-α,COR,AT-II水平差异无统计学意义(P>0.05)。术后2 h,4 h,24 h A组VAS评分均低于B组(P<0.05)。A组术后48 h内PCIA按压次数显著少于B组(P<0.05)。A组在术后2 h,4 h时点IL-6,TNF-α,COR,AT-II水平较B组低(P<0.05)。与术前相比,两组的CD3^(+),CD4^(+),CD4^(+)与CD8^(+)的比值、NK细胞水平在术后4 h,24 h均明显降低(P<0.05)。A组在术后4 h,24 h的CD3^(+),CD4^(+),CD4^(+)与CD8^(+)比值、NK细胞水平高于B组(P<0.05)。帕瑞昔布钠可降低乳腺癌改良根治术患者术后炎症因子及应激激素的释放,提高患者细胞免疫反应,增强术后镇痛效果。

In order to investigate the effects of Parecoxib sodium on postoperative pain,inflammatory factors and immune response in patients undergoing modified radical mastectomy,80 patients with breast cancer undergoing radical mastectomy were randomly divided into two groups:Parecoxib sodium group(Group A,n=40)and control group(Group B,n=40).At 15 min before anesthesia induction,patients in the Group A received 40 mg of Parecoxib sodium intravenously,while those in Group B received 5 mL of normal saline intravenously.Before anesthesia induction,2 h after the operation,4 h after the operation,and 24 h after the operation,2 mL of venous blood was collected from the two groups of patients at each time point.Plasma levels of IL-6,TNF-α,COR,AT-II were detected by enzymatic linked immunosorbent assay(ELISA).The percentages of T lymphocyte subsets(CD3^(+),CD4^(+),CD8^(+))and natural killer cells(NK cells)(CD3-,CD16^(+),CD56^(+))were determined by flow cytometry.Visual analogue scale(VAS)of pain was recorded at 2,4,24 and 48 h postoperatively,and the times of controlled analgesia were recorded within 48 h postoperatively.There was no significant difference in VAS score,T lymphocyte subsets and NK cell distribution ratio,plasma IL-6,TNF-α,COR,AT-II levels between the two groups before surgery.The VAS scores of Group A were lower than those of Group B at 2,4 and 24 h after operation(P<0.05).The number of PCIA compressions within 48 h after operation in Group A was significantly less than that in Group B(P<0.05).The levels of IL-6,TNF-α,COR and AT-II in Group A were lower than those in Group B at 2 and 4 h after operation(P<0.05).Compared with the preoperative period,the CD3^(+),CD4^(+),ratio of CD4^(+)and CD8^(+),and NK cell levels of the two groups were significantly reduced at 4 and 24 h after surgery(P<0.05).The CD3^(+),CD4^(+),ratio of CD4^(+)and CD8^(+),and the level of NK cells in Group A were higher than those in Group B at 4 and 24 h after surgery(P<0.05).Parecoxib sodium can decrease the release of inflammatory factors and stress hormones after modified radical mastectomy,improve the cellular immune response and enhance the analgesic effect.