摘要
目的观察氟比洛芬酯注射液用于消化道肿瘤切除手术术后镇痛的临床效果及其对术后细胞因子表达的影响。方法60例上腹部手术患者,随机分为三组,每组20例。M组术后使用吗啡自控静脉内镇痛(PCIA)泵(负荷剂量0.03mg/kg,1mg/次,锁定时间15min,背景剂量为0);F组,手术结束时静脉注射氟比洛芬酯50mg,术后12、24、36h分别静脉注射氟比洛芬酯50mg,术后采用吗啡PCIA泵,设置同M组;P组,手术开始前30min,静脉注射氟比洛芬酯50mg,术后12、24、36h分别静脉注射氟比洛芬酯50mg,术后采用吗啡PCIA泵,设置同M组。观察6、12、24、36、48h各组静息时视觉模拟评分(VAS)、48h吗啡总用量,并采集麻醉诱导前和切皮后6、12、24h外周静脉血测定血浆细胞因子白细胞介素-6(IL-6)、白细胞介素-10(IL-10)浓度。结果术后6h,P组VAS明显低于M组。术后12h,P组及F组VAS均明显低于M组。此外,M组术后48h吗啡总用量明显多于P组及F组。三组患者术前IL-6、IL-10几乎不可测到,切皮后6h,三组血浆IL-10均达峰值,但M组明显低于P组及F组。切皮后12h三组IL-6达峰值,其中M组明显高于P组及F组,24hM组仍明显高于P组。结论术前预给予氟比洛芬酯注射液能更好的控制消化道肿瘤切除术术后的重度疼痛,并明显减少吗啡用量,此外还能明显减少术后炎症细胞因子IL-6生成,促进抗炎因子IL-10的释放。
Objective To investigate the analgesic effect and impact on the inflammatory cytokines response of the lipid microspheres flurbiprofen axetil injection in patients undergoing gastroenteral cancer transection surgery. Methods Sixty patients scheduled to take gastroenteral cancer transection surgery were randomly allocated into three groups, morphine group （M, n = 20）, postoperative flurbiprofen axetil group（F, n = 20） and preemptive flurbiprofen axetil group （P, n = 20）. In group M the patients received patient controlled intravenous analgesia （PCIA） with morphine （loading dose 0.03 mg/kg, bolus 1 mg,lockout time 15 min,background dose 0 mg） after surgery. As for group F, 50 mg flurbiprofen axetil were administered at the end of the surgery, then the same morphine PCIA scheme as group M was used in combination with the intermitted intravenous injection of flurbiprofen axetil per 50 mg at 12 h, 24 h, 36 h after surgery. The analgesic paradigm of group P was quite similar with group F, whereas the first injection of flurbiprofen axetil was administered 30 rain before operation instead of the end of surgery. The analgesic effect assessed by visual analog scale （VAS） at rest at 6, 12, 24, 36, and 48 h after operation and the total consumed dosage of morphine were recorded. Furthermore, the venous blood was drawn before the induction of anesthesia, 6, 12, and 24 h after the surgery to determine the level of interleukin 6 （IL-6） and interleukin 10 （IL-10）. Results At 6 h after surgery, the VAS of group P was significantly lower than group M. At 12 h post operation, the VAS of the group P and group F was markedly lower than group M. Moreover, the total consumed dosage of morphine was significantly less in the group P and group F compared with the group M. The basic level of IL-6 and IL-10 was too low to be measured. The concentration of IL-10, IL-6 reached peak levels at 6 h, 12 h after surgery respectively, and the level of IL-10 of the group M was significantly lower than the group F and group P at 6 h. In contrast, IL-6 of the group M was significantlyhigher than the group F and group P at 12 h, and still higher than the group P at 24 h. Conclusion Preemptive administration of the lipid microspheres flurbiprofen axetil might better control fierce pain after gastroenteral cancer transection surgery. Furthermore it could attenuate the inflammatory cytokines response through the inhibition of the expression of IL-6 and enhancement the production of IL-10.
出处
《临床麻醉学杂志》
CAS
CSCD
2007年第5期382-384,共3页
Journal of Clinical Anesthesiology
