氟比洛芬酯超前镇痛联合利多卡因喷喉对围术期患者疼痛程度和炎性及应激反应的影响

Effects of flurbiprofen axetil preemptive analgesia combined with lidocaine throat-spraying on pain,inflammation and stress response in perioperative patients

目的观察氟比洛芬酯静脉注射联合利多卡因喷喉对全身麻醉围术期患者疼痛程度和炎性及应激反应的影响。方法选取2013年8—10月首都医科大学附属北京妇产医院在全身麻醉下行腹腔镜子宫肌瘤切除术的患者80例,采用随机数字表法分为对照组(C组)、利多卡因组(L组)、氟比洛芬酯组(F组)、氟比洛芬酯联合利多卡因组(LF组),每组20例。C组麻醉诱导前静脉预注射0. 9%氯化钠注射液10 ml; L组麻醉诱导起效后用2%利多卡因注射液5 ml喷喉; F组麻醉诱导前静脉预注射10 ml氟比洛芬酯注射液(100 mg); LF组麻醉诱导前静脉预注射5 ml氟比洛芬酯注射液(50 mg),麻醉诱导起效后用2%利多卡因注射液5 ml喷喉。分别于术前(T1)、术毕拔除气管导管时(T2)、术后6 h(T3)记录患者的平均动脉压和心率,检测患者血浆白细胞介素6和皮质醇浓度。于T3时记录患者疼痛视觉模拟量表(VAS)评分和按压静脉自控镇痛泵的次数。结果 4组患者基本情况差异无统计学意义(P> 0. 05)。与T1时比较,C组和F组T2、T3时平均动脉压、心率均增加,差异均有统计学意义(均P <0. 05)。与C组比较,L组、F组、LF组T2、T3时白细胞介素6和皮质醇水平均降低[白细胞介素6:(0. 52±0. 24)、(0. 66±0. 29)、(0. 43±0. 16) ng/L比(0. 72±0. 52) ng/L,(1. 15±0. 69)、(0. 82±0. 43)、(0. 53±0. 41) ng/L比(1. 46±0. 68) ng/L,皮质醇:(0. 074±0. 051)、(0. 083±0. 048)、(0. 049±0. 036) ng/L比(0. 125±0. 063) ng/L,(0. 139±0. 054)、(0. 152±0. 051)、(0. 080±0. 057) ng/L比(0. 354±0. 251) ng/L],其中LF组最低,差异均有统计学意义(均P <0. 05)。各组T3时VAS评分差异无统计学意义,到T3时各组静脉自控镇痛泵按压次数差异无统计学意义(均P> 0. 05)。结论氟比洛芬酯预先静脉注射联合利多卡因喷喉可以降低机体围术期应激与炎性反应。

Objective To observe the effect of pre-intravenous administration of flurbiprofen axetil combined with throat-spraying of lidocaine on pain,inflammation and stress response in perioperative patients with general anesthesia.Methods Eighty patients undergoing laparoscopic myomectomy with general anesthesia from August to October 2013 in Beijing Obstetrics and Gynecology Hospital,Capital Medical University were randomly divided into control group(group C),lidocaine group(group L),flurbiprofen axetil group(group F)and flurbiprofen axetil combined with lidocaine group(group LF),with 20 cases in each group.The group C had intravenous administration of 0.9%sodium chloride 10 ml before anesthesia induction.The group L had 2%lidocaine 5 ml sprayed to throat after induction.The group F had intravenous administration of flurbiprofen axetil 10 ml(100 mg)before induction.The LF group had pre-intravenous administration of flurbiprofen axetil 5 ml(50 mg)and throatspraying of 2%lidocaine 5 ml after induction.Mean arterial pressure,heart rate,levels of plasma interleukin-6 and cortisol were recorded before surgery(T1),during extubation(T2)and 6 h after surgery(T3).Visual Analogue Scale(VAS)was assessed at T3 and using times of patient-controlled intravenous analgesia were analyzed.Results Baseline data were similar among the four groups(P>0.05).Mean arterial pressure and heart rate at T2 and T3 were significantly higher than those at T1 in group C and group F(all P<0.05).At T2 and T3,levels of interleukin-6 and cortisol in group L,group F and group LF were significantly lower than those in group C[interleukin-6:(0.52±0.24),(0.66±0.29),(0.43±0.16)ng/L vs(0.72±0.52)ng/L;(1.15±0.69),(0.82±0.43),(0.53±0.41)ng/L vs(1.46±0.68)ng/L;cortisol:(0.074±0.051),(0.083±0.048),(0.049±0.036)ng/L vs(0.125±0.063)ng/L;(0.139±0.054),(0.152±0.051),(0.080±0.057)ng/L vs(0.354±0.251)ng/L];the levels in group LF were significantly lower than those in group L and group F(all P<0.05).There was no significant difference of VAS score and using times of patient-controlled analgesia among the four groups(P>0.05).Conclusion Pre-intravenous administration of flurbiprofen axetil combined with throat-spraying of lidocaine can inhibit perioperative inflammation and stress response in patients with general anesthesia.