羟考酮联合帕瑞昔布钠超前镇痛对腹腔镜下子宫切除术患者围术期应激反应及血清CXCL13、CXCR5影响

Impact of preemptive analgesia of oxycodone combined with parecoxib sodium during laparoscopic hysterectomy on the perioperative stress response and serum CXC chemokine 13 and CXC chemokine receptor 5 expression levels

目的:分析羟考酮联合帕瑞昔布钠超前镇痛对腹腔镜下子宫切除患者围术期应激反应及血清CXC趋化因子13(CXCL13)、CXC趋化因子受体5(CXCR5)表达的影响。方法:选取2019年6月-2021年6月本院行腹腔镜下子宫切除术患者98例,随机数字表法分为对照组(n=49),给予羟考酮超前镇痛与观察组(n=49),在对照组基础上加用帕瑞昔布钠。比较两组手术相关指标,包括手术用时、术中出血量、苏醒时间以及MMSE认知功能评分等,氧化应激相关指标、并发症,使用视觉模拟评分法(VAS)评估两组术后疼痛程度,并检测血CXCL13、CXCR5水平。结果:两组手术用时、手术出血量、苏醒时间以及MMSE认知功能评分无差异(P>0.05)。术后24h观察组C反应蛋白(37.14±5.32 mg/L)、皮质醇(165.32±18.14 nmol/L)、去甲肾上腺素(NE)(42.16±5.27μg/L)等氧化应激指标水平均低于对照组(42.13±5.36 mg/L、177.31±17.76 nmol/L、49.30±5.21μg/L),术后2hVAS评分(6.65±1.03分)、6h(5.06±0.72分)、12h(4.03±0.67分)、24h(2.34±0.61分)、48h(0.78±0.25分)均低于对照组(7.54±1.16分、5.94±0.78分、5.03±0.82分、3.54±0.74分、1.55±0.42分),术后两组血清CXCL13、CXCR5水平均较术前低且观察组(40.08±6.55 ng/ml、43.28±4.46 ng/ml)低于对照组(53.43±7.24 ng/ml、55.24±5.67 ng/ml),观察组并发症发生率(14.3%)低于对照组(38.8%)(P<0.05)。结论:腹腔镜下子宫切除术羟考酮联合帕瑞昔布钠超前镇痛可有效降低患者围术期应激反应及血清CXCL13、CXCR5表达水平,提高临床效果且降低并发症发生。

Objective:To analyze the impact of preemptive analgesia with oxycodone combined of parecoxib sodium during laparoscopic hysterectomy of patients on their perioperative stress response and the serum CXC chemokine 13(CX-CL13)and CXC chemokine receptor 5(CXCR5)expression levels.Methods:98 patients who wanted laparoscopic hysterectomy were selected and were divided into two groups according to random number table method from June 2019 to June 2021.49 patients in the control group were given preemptive analgesia of oxycodone and 49 patients in the observation group were given preemptive analgesia of oxycodone combined with parecoxib sodium.The operation-related indicators,such as operation time,intraoperative blood loss,recovery time,and MMSE cognitive function score,the oxidative stress-related indicators,and the complications rate of the patients were compared between the two groups.The postoperative pain degree of the patients in the two groups was assessed by visual analogue scale(VAS),and the expression levels of CXCL13 and CXCR5 of the patients in the two groups were detected.Results:There were no significant differences in the operative time,the operative blood loss,the recovery time,and the MMSE cognitive function score of the patients between the two groups(P>0.05).The levels of oxidative stress indexes,such as C-reactive protein(37.14±5.32 mg/L),cortisol(165.32±18.14 nmol/L),and norepinephrine(NE)(42.16±5.27μg/L)of the patients at 24h after operation in the observation group were significantly lower than those(42.13±5.36mg/L,177.31±17.76 nmol/L,and 49.30±5.21μg/L)of the patients in the control group.The VAS scores at 2h after operation(6.65±1.03 points),6h after operation(5.06±0.72 points),12h after operation(4.03±0.67 points),24h after operation(2.34±0.61 points)and 48h after operation(0.78±0.25 points)of the patients in the observation group were significantly lower than those(7.54±1.16 points,5.94±0.78 points and 5.03±0.82 points,3.54±0.74 points,and 1.55±0.42 points)of the patients in the control group.After operation,the levels of serum CXCL13 and CXCR5 of the patients in both groups were significantly lower than those before operation,and which(40.08±6.55 ng/ml and 43.28±4.46 ng/ml)of the patients in the observation group were significantly lower than those(53.43±7.24 ng/ml and 55.24±5.67 ng/ml)of the patients the control group.The complication rate(14.3%)of the patients in the observation group was significantly lower than that(38.8%)of the patients in the control group(P<0.05).Conclusion:Preemptive analgesia of oxycodone combined with parecoxib sodium during laparoscopic hysterectomy of the patients can effectively reduce their perioperative stress response and their expression levels of serum CXCL13 and CXCR5,and can increase their clinical effect with less complications.