摘要
目的探讨分析帕瑞昔布钠联合胸椎旁神经阻滞对老年胸科手术患者血清血栓调节蛋白(thrombomodulin,TM)及高迁移率族蛋白1(high mobility group box 1 protein, HMGB1)的影响。方法选择2017年8月至2018年8月解放军总医院第一医学中心行胸科手术的老年患者130例,依据镇痛药物及镇痛方式不同分为对照组与研究组,每组65例。对照组给予帕瑞昔布钠静脉滴注治疗,研究组给予帕瑞昔布钠联合胸椎旁神经阻滞治疗。结果术后48 h研究组血清TM、HMGB1及CRP水平均显著低于对照组(P<0.05),恶心呕吐等不良反应的发生率均显著低于对照组(P<0.05);术后48 h,研究组血清炎性分子水平均较术前升高,而皮质醇(Cor)、TNF、IL-6水平均低于对照组,IL-10水平高于对照组(P<0.05);术后安静状态下两组疼痛评分差异无统计学意义(P>0.05),术后咳嗽时研究组舒适度评分(Bruggrmann comfort scale, BCS)高于对照组(P<0.05)。结论对进行胸科手术的老年患者进行帕瑞昔布钠联合胸椎旁神经阻滞治疗,可降低术后患者血清中TM、HMGB1及炎性因子水平,降低不良反应的发生率,镇痛效果良好,值得临床推广。
Objective To investigate the effect of parecoxib sodium combined with parathoracic nerve block on serum thrombomodulin(TM) and high mobility group box 1 protein(HMGB1) in elderly patients undergoing thoracic surgery.Methods One hundred and thirty elderly patients who underwent thoracic surgery in the First Medical Center of Chinese PLA General Hospital from August 2017 to August 2018 were divided into control group(65 patients) and study group(65 patients). The control group was treated with parecoxib sodium, and the study group was treated with parecoxib sodium combined with thoracic paravertebral nerve block. Results The serum levels of TM, HMGB1 and CRP in the study group were significantly lower than those in the control group at 48 hours after operation(P < 0.05), and the incidence of nausea and vomiting was significantly lower than that in the control group(P < 0.05). At 48 hours after operation, the levels of inflammatory molecules in the study group were higher than those before operation, while the levels of cortisol(Cor), TNF and IL-6 were lower than those in the control group, while the levels of IL-10 were higher. There was no significant difference between the two groups in pain score of the quiet state after operation(P > 0.05). The pain score in the study group was higher than that in the control group when coughing after operation, and the degree of pain was lower(P < 0.05). Conclusions Parecoxib sodium combined with parathoracic nerve block can reduce the levels of TM, HMGB1 and inflammatory factors in the serum of elderly patients undergoing thoracic surgery, and also reduce the incidence of adverse reactions, and have a good analgesic effect. It is worth popularizing in clinical practice.
作者
杨冉
刘毅
丛霆
傅强
Yang Ran;Liu Yi;Cong Ting;Fu Qiang(Anesthesia and Operation Center, the First Medical Center of Chinese PLA General Hospital, Beijing 100853, China)
出处
《北京医学》
CAS
2019年第8期641-644,共4页
Beijing Medical Journal
基金
解放军总医院临床科研扶持基金(2016FC-TSYS-1025)
关键词
帕瑞昔布钠
胸椎旁神经阻滞
胸科手术
血栓调节蛋白
高迁移率族蛋白1
老年
parecoxib sodium
thoracic paravertebral nerve block
chest surgery
serum thrombomodulin(TM)
high mobility group box 1 protein(HMGB1)
elderly
