摘要
目的探讨帕瑞昔布钠超前镇痛在腹腔镜手术中的应用价值及其对机体免疫细胞因子、应激激素分泌的影响。方法2017年12月~2019年5月在本院行子宫全切术的子宫肌瘤患者88例,按照随机数字表法将患者分为对照组、观察组,各44例。两组患者均接受全凭静脉麻醉、术后给予静脉自控镇痛(PCA);观察组在麻醉诱导前15min静脉注射帕瑞昔布钠40mg,对照组在相同时间点给予等量生理盐水。对比两组患者术前及术后6、12、24h的P物质(SP)、5-羟色胺(5-HT)、T淋巴细胞亚群(CD3^(+)、CD4^(+)、CD8^(+))、NK细胞分布比例、皮质醇(Cor)、生长激素(GH)、去甲肾上腺素(NE)、肾上腺素(E)水平的差异,记录首次触发PCA泵时间、有效按压次数。结果术前两组患者的疼痛视觉模拟评分(VAS)、T淋巴细胞亚群及NK细胞分布比例、应激激素水平差异无统计学意义(P>0.05)。术后6、12、24h,观察组VAS评分低于对照组,CD3^(+)、CD4^(+)T淋巴细胞及NK细胞分布比例高于对照组,Cor、GH、NE、E的水平低于对照组,差异均有统计学意义(P<0.05)。观察组术后首次触发PCA泵时间长于对照组,术后不同时间段内的有效按压次数少于对照组,差异均有统计学意义(P<0.05)。结论帕瑞昔布钠超前镇痛可减轻腹腔镜子宫全切术患者的术后疼痛,在调节机体免疫状态、抑制应激反应方面也有积极作用。
Objective To explore the value of parecoxib sodium preemptive analgesia in laparoscopic surgery and its effect on the secretion of immune cytokines and stress hormones.Methods A total of 88 patients with hysteromyoma who underwent total hysterectomy in our hospital from December 2017 to May 2019 were divided into control group and observation group according to random number table method,44 patients in each group.Both groups received total intravenous anesthesia and postoperative intravenous controlled analgesia(PCA).Patients in the observation group were given 40mg parecoxib sodium intravenous 15min before anesthesia induction,while patients in the control group were given equal volume normal saline at the same time point.Compared two groups of patients with preoperative and postoperative 6h,12h and 24h after surgery postoperative pain medium substance P(SP)and serotonin(5-HT),the T lymphocyte subsets(CD3^(+),CD4^(+),CD8^(+))and NK cells distribution proportion and Cor,GH,NE,(Epinephrine,E)level,And the difference of the first trigger time and effective pressing times of PCA pump.Results There were no statistically significant differences in VAS scores,T lymphocyte subsets,NK cell distribution and stress hormone levels between the two groups before surgery(P>0.05).VAS scores of patients in the observation group were lower than those in the control group 6h,12h and 24h after surgery.The proportion of CD3^(+),CD4^(+)T lymphocytes and NK cells was higher than that of the control group.The levels of Cor,GH,NE and E were lower than those of the control group(P<0.05).The first trigger time of PCA pump in the observation group was longer than that in the control group,and the effective pressure times in different postoperative periods were less than those in the control group(P<0.05).Conclusion Parecoxib sodium preemptive analgesia can actively relieve postoperative pain in patients undergoing laparoscopic total hysterectomy,and has a positive effect on regulating immune state and inhibiting stress response.
作者
韩庆波
蔡立松
李永敏
刘洋
郭平选
HAN Qingbo;CAI Lisong;LI Yongmin(Anesthesiology Department,Kailuan General Hospital of Tangshan Hebei Province,Tangshan 063000,China)
出处
《华北理工大学学报（医学版）》
2021年第2期89-93,118,共6页
Journal of North China University of Science and Technology：Health Sciences Edition
基金
河北省卫生和计划委员会2016年度重点科技研究计划(编号:182497-2)。
