帕瑞昔布联合舒芬太尼在腹腔镜肾癌根治术后的镇痛效应及对免疫功能的影响

Analgesic effect of parecoxib sodium combined with sufentanil after laparoscopic radical nephrectomy and its effect on immune function

目的探讨帕瑞昔布联合舒芬太尼在腹腔镜肾癌根治术后镇痛效应及其对免疫功能的影响。方法选取2018年2月至2019年6月收治的行腹腔镜肾癌根治手术治疗的晚期肾癌患者64例,随机分为对照组和研究组,每组32例。研究组于麻醉诱导前30 min静脉注射帕瑞昔布钠,对照组静脉注射0.9%氯化钠溶液,术毕清醒后立即进行舒芬太尼自控镇痛泵。对比2组患者术后镇痛前(T0)及术后镇痛6 h(T1)、12 h(T2)、24 h(T3)及48 h(T4)的视觉模拟(VAS)评分和疼痛分级法(NRS)评分、T0和T4时血流动力学指标[心率(HR)、平均动脉压(MAP)]、T0和T4时免疫功能相关指标[CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)],并记录2组不良反应发生情况。结果VAS评分、NRS评分组间、时间的主效应差异有统计学意义(P<0.05),时间与组间存在交互作用(P<0.05)。T0时2组患者HR、MAP差异无统计学意义(P>0.05),与T0时相比,T4时2组患者HR、MAP均显著降低(P<0.05),且研究组HR、MAP显著低于对照组(P<0.05)。T0时2组患者CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平差异无统计学意义(P>0.05);T4时研究组患者CD3^(+)、CD4^(+)、水平显著高于对照组(P<0.05)。用药后48 h内,2组不良反应发生率比较差异无统计学意义(P>0.05)。结论帕瑞昔布联合舒芬太尼术后镇痛用于腹腔镜肾癌根治术患者,能达到良好的术后镇痛效果,并且能够有效改善患者术后的免疫功能,且安全性更高,值得临床推广。

Objective To investigate the analgesic effect of parecoxib sodium combined with sufentanil after laparoscopic radical nephrectomy and its effect on immune function.Methods A total of 64 patients with advanced renal cell carcinoma who were treated with laparoscopic radical nephrectomy from February 2018 to June 2019 were randomly divided into control group and study group,with 32 cases in each group.Intravenous injection of parecoxib sodium,and normal saline 30 minutes before the induction of anesthesia was given to patients of study group and control group,respectively.Sufentanil administration using the patient-controlled analgesia pump was immediately given after waking up.The visual analogue Scale(VAS)score and the Numerical Rating Scale(NRS)scores before(T0)and 6h(T1),12h(T2),24h(T3)and 48h(T4)after postoperative analgesia were compared between the two groups.In addition,hemodynamic indicators(heart rate[HR],mean arterial pressure[MAP])at T0 and T4,and immune function-related indicators(CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+))at T0 and T4 were compared between groups.Adverse events were recorded.Results There were significant differences in the main effects of the VAS score,NRS score and time between groups(all P<0.05),and a time×group interaction existed(P<0.05).There were no significant differences in HR and MAP at T0 between the two groups(P>0.05).Compared with those at T0,HR and MAP at T4 in both groups were significantly lower(P<0.05),which were significantly lower in the study group than those in control group(P<0.05).There were no significant differences in the CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)at T0 between groups(all P>0.05).At T4,CD3^(+),CD4^(+)in the study group were significantly higher than those in the control group(all P<0.05).There was no significant difference in the incidence of adverse events within 48 h of medications between groups(P>0.05).Conclusion Parecoxib sodium combined with sufentanil for postoperative analgesia in patients undergoing laparoscopic radical nephrectomy can achieve a good effect of postoperative analgesia,effectively improve the postoperative immune function,and with high safety.It is worthy of clinical promotion.