帕瑞昔布钠超前镇痛对乳腺癌根治术患者心血管反应及术后疼痛的影响

帕瑞昔布钠论文：帕瑞昔布钠在不同时点应用对乳腺癌术后镇痛效果及不良反应对比【中文摘要】乳腺癌手术由于手术范围广、创伤大、术后疼痛中等,术后需要镇痛。

良好的术后镇痛能明显抑制疼痛引起的应激反应,有利于咳嗽、排痰和术后早期下床活动,能减少肺部并发症和下肢深静脉血栓的形成。

目前临床常用哌替啶、吗啡、曲马多、芬太尼等进行术后镇痛,虽然效果确切,但副作用明显,如恶心、呕吐、瘙痒等,给患者及其家属带来困扰。

帕瑞昔布钠是一种新型的特异性环氧化酶2(COX-2)抑制剂,无抗血小板作用,不会增加出血危险,临床上主要用于与创伤和手术有关的急性疼痛的短期治疗,现已知帕瑞昔布钠可作用于中枢神经系统产生超前镇痛作用,其用药时机与其镇痛效果有关,如何使用该药才能充分发挥它的优势还需要进一步的临床探讨。

研究观察不同时点应用帕瑞昔布钠对于全身麻醉下乳腺癌改良根治术患者术后镇痛的临床效果及其对机体应激反应的影响、不良反应等,从而探求一种更加合理、安全、有效的解决乳腺癌改良根治术术后疼痛的方法。

研究方法选择ASAⅠ—Ⅱ级、年龄25—70岁择期行乳腺癌改良根治术患者90例,所有入选病例均采用静吸复合全麻。

以咪唑安定、芬太尼、丙泊酚、顺式阿曲库铵静脉诱导行气管内插管,术中以丙泊酚、瑞芬太尼、顺式阿曲库铵持续输注,七氟烷吸入维持麻醉,术中切皮开始给予芬太尼静注入选病例随机分为三组：A组(术前给药组)、B组(术后给药组)、N组(对照组)。

A组于手术开始前30min静脉注射帕瑞昔布钠(特耐)40mg,于术中乳房组织切除、腋窝淋巴结清扫完成后静注生理盐水5ml；B组于手术开始前30min静注生理盐水5ml,术中乳房组织切除及腋窝淋巴结清扫完成后静注帕瑞昔布钠40mg；N组于术前30min及术中乳房组织切除、腋窝淋巴结清扫完成后分别静注生理盐水5ml。

所有病人于缝皮时给予托烷司琼5mg静脉注射预防恶心、呕吐。

术后拔除气管导管,送返乳腺外科病房,根据病人疼痛主诉,追加哌替啶75mg肌注。

帕瑞昔布钠对乳腺癌改良根治术患者术后镇痛的效果储晓英;夏一梦;张富军;伍明明【期刊名称】《上海交通大学学报（医学版）》【年(卷),期】2013(033)002【摘要】Objective To investigate the effects of administration of parecoxib sodium at different time points on analgesia after modified radical mastectomy for breast cancer. Methods Sixty patients undergoing modified radical mastectomy for breast cancer under general anesthesia were selected and divided into four groups, with 15 patients in each group. Group A received 2 mL normal saline during anesthesia induction, group B 40 mg parecoxib sodium during anesthesia induction, group C 40 mg parecoxib sodium at the end of surgery, and group D 40 mg parecoxib sodium both during anesthesia induction and at the end of surgery. Parecoxib sodium was intravenously administered after dilution into 2 mL normal saline in group B, group C and group D. Fentanyl was supplemented to the requirement of patients during analepsia. Visual analogue scale (VAS) scores were recorded 2, 12 and 24 h after surgery, VAS motion scores and analgesic satisfaction rates were obtained 24 h after surgery, and the occurrence of nausea and vomiting were observed after surgery. Results The VAS scores 2, 12 and 24 h after surgery in group B, group C and group D were significantly lower than those in group A (P < 0. 01) , and the VAS scores 12 h after surgery in group B and group Dwere significantly lower than those in group C (P <0. 05) . The VAS motion scores 24 h after surgery in group B, group C and group D were significantly lower than that in group A (P < 0. 01), and the VAS motion score 24 h after surgery in group B was significantly higher than that in group D (P <0. 05) . The analgesic satisfaction rates 24 h after surgery in group B, group C and group D were higher than that in group A. The prevalences of nausea and vomiting 12 and 24 h after surgery in group B, group C and group D were lower than those in group A. Conclusion Parecoxib sodium plays a role in preemptive analgesia for patients undergoing modified radical mastectomy for breast cancer, which may improve postoperative pain control and analgesic satisfaction rate and reduce the incidence of nausea and vomiting. Administration of parecoxib sodium both during anesthesia induction and at the end of the surgery may yield better results.%目的比较不同时间点给予帕瑞昔布钠对乳腺癌改良根治术患者术后镇痛效果的影响.方法选取全身麻醉下行乳腺癌改良根治术患者60例,分为4组,每组15例:A组麻醉诱导同时给予2 mL生理盐水,B组麻醉诱导同时予帕瑞昔布钠40 mg,C组缝皮前给予帕瑞昔布钠40 mg,D组麻醉诱导同时和缝皮前分别给予帕瑞昔布钠40 mg,帕瑞昔布钠均用生理盐水稀释成2 mL静脉注射.苏醒期根据患者主诉追加芬太尼至患者满意.记录术后2、12和24 h患者的视觉模拟疼痛评分(VAS),24 h VAS运动评分和镇痛满意率,以及术后恶心、呕吐情况.结果 B、C、D组术后2、12、24 h VAS评分均显著低于A组(P＜0.01),B组和D 组术后12 h VAS评分均显著低于C组(P＜0.05).B、C、D组术后24 h VAS运动评分均显著低于A组(P＜0.01),B组术后24 h VAS运动评分显著高于D组(P＜0.05).B、C、D组术后24 h镇痛满意率均高于A组.B、C、D组术后12、24 h恶心、呕吐发生率低于A组.结论帕瑞昔布钠对乳腺癌改良根治术患者具有超前镇痛作用,可提高患者术后镇痛效果和镇痛满意率,减少术后恶心、呕吐发生率；麻醉诱导同时和缝皮前均给予帕瑞昔布钠可能效果更佳.【总页数】4页(P196-199)【作者】储晓英;夏一梦;张富军;伍明明【作者单位】上海交通大学医学院附属瑞金医院麻醉科,上海200025【正文语种】中文【中图分类】R971.2【相关文献】1.用帕瑞昔布钠对进行乳腺癌改良根治术患者实施术后镇痛治疗的效果观察 [J], 夏云;杨晓斌;陆文汉2.帕瑞昔布钠对经皮肾镜患者术后镇痛的临床效果 [J], 钱宁3.帕瑞昔布钠在四肢创伤骨折患者术后镇痛中的效果分析 [J], 李卓伟4.帕瑞昔布钠超前镇痛对腹腔镜胆囊切除术患者术后镇痛效果的影响 [J], 郑蓓5.氯诺昔康联合帕瑞昔布钠对接受下肢骨科手术的患者进行术后镇痛治疗的效果分析 [J], 唐燕;廖申坤因版权原因，仅展示原文概要，查看原文内容请购买。

第16期2022年6月江苏科技信息Jiangsu Science &Technology InformationNo.16June,2022基金项目:新疆维吾尔自治区自然科学基金面上项目;项目编号:2017D01C372㊂作者简介:侯彦深(1980 ),男,河南杞县人,主治医师,硕士;研究方向:临床麻醉㊂∗通信作者:齐国强(1980 ),男,安徽阜阳人,副主任医师,学士;研究方向:临床麻醉㊂帕瑞昔布钠对乳腺癌改良根治术患者炎症因子及免疫功能的影响研究侯彦深1,齐国强2∗(1.新疆医科大学附属肿瘤医院麻醉科,新疆乌鲁木齐830011;2.新疆乌鲁木齐市第一人民医院麻醉科,新疆乌鲁木齐830011)摘要:为探讨帕瑞昔布钠对乳腺癌改良根治术患者术后疼痛㊁炎症因子㊁免疫功能的影响,文章选择乳腺癌改良根治术患者80例,按照随机数字表法分成帕瑞昔布钠组(A 组)和对照组(B 组),每组各40例㊂在麻醉诱导前15min ,A 组患者静脉注射帕瑞昔布钠40mg ,B 组患者静脉注射生理盐水5mL ㊂术后两组患者均给予舒芬太尼镇痛泵行自控镇痛(PCIA )㊂于麻醉诱导前㊁手术结束后2h ㊁手术结束后4h ㊁手术结束后24h 各时点采集两组患者静脉血2mL ,采用酶联免疫吸附法(ELISA )检测血浆IL -6,TNF -α,COR ,AT -II 水平,采用流式细胞术检测T 淋巴细胞亚群(CD3+,CD4+,CD8+)及自然杀伤细胞(natural killer cell ,NK )(CD3-,CD16+,CD56+)的百分比,并记录术后2h ,4h ,24h ,48h 两组患者疼痛视觉模拟评分(VAS ),以及48h 内自控镇痛按压次数㊂结果显示:术前两组患者的VAS 评分㊁T 淋巴细胞亚群及NK 细胞分布比例㊁血浆IL -6,TNF -α,COR ,AT -II 水平差异无统计学意义(P >0.05)㊂术后2h ,4h ,24h A 组VAS 评分均低于B 组(P <0.05)㊂A 组术后48h 内PCIA 按压次数显著少于B 组(P <0.05)㊂A 组在术后2h ,4h 时点IL -6,TNF -α,COR ,AT -II 水平较B 组低(P <0.05)㊂与术前相比,两组的CD3+,CD4+,CD4+与CD8+的比值㊁NK 细胞水平在术后4h ,24h 均明显降低(P <0.05)㊂A 组在术后4h ,24h 的CD3+,CD4+,CD4+与CD8+比值㊁NK 细胞水平高于B 组(P <0.05)㊂帕瑞昔布钠可降低乳腺癌改良根治术患者术后炎症因子及应激激素的释放,提高患者细胞免疫反应,增强术后镇痛效果㊂关键词:帕瑞昔布钠;乳腺癌改良根治术;炎症因子;免疫反应中图分类号:R737.9㊀㊀文献标志码:A 0㊀引言㊀㊀手术创伤㊁麻醉及术后疼痛常常触发患者神经㊁内分泌和免疫调控网络紊乱,抑制患者术后免疫应答,引起机体应激反应,影响患者术后康复过程㊂手术相关的组织损伤引起炎症反应,伴随着促炎症因子水平的升高,包括肿瘤坏死因子-α(TNF -α)和白细胞介素-6(IL -6)可以通过环氧化酶-2(COX -2)依赖途径引起外周和中枢神经系统敏化,导致痛觉过敏,有效的镇痛能降低机体应激反应与炎症因子水平,有助于改善患者预后[1-2]㊂帕瑞昔布钠属于高特异性环氧化酶-2(COX -2)抑制剂非甾体抗炎药,与非特异性非甾体类抗炎药相比,可降低血小板聚集和胃肠道不良反应的发生率,是围手术期镇痛药,临床上主要用于患者术后疼痛的短期治疗[3]㊂研究表明,帕瑞昔布在乳腺癌改良根治术术后急性疼痛治疗中具有较好的疗效,并且与阿片类药物联合使用具有保持阿片类药物的保护作用[4]㊂然而帕瑞昔布联合舒芬太尼围手术期镇痛对乳腺癌改良根治术患者术后炎症因子㊁应激反应,特别是对免疫功能的影响尚无深入研究㊂因此,本研究以超前镇痛概念为基础,旨在探讨帕瑞昔布钠对乳腺癌患者术后炎症因子㊁应激反应及免疫功能的影响㊂1㊀资料与方法1.1㊀一般资料㊀㊀本研究已得到新疆医科大学附属肿瘤医院伦理委员会的批准(G-201307),所进行的工作符合‘赫尔辛基宣言“的规定㊂在参与本研究之前所有患者都签署知情同意书㊂选择2019年1 12月期间在新疆医科大学附属肿瘤医院接受乳腺癌癌根治术患者80例,ASA I~Ⅱ级,年龄35 65岁,体质量指数(Body Mass Index,BMI)18~25㊂排除标准:有慢性疼痛病史,长期使用镇痛药,存在精神病史或不能理解VAS评分的患者㊂1.2㊀分组㊀㊀利用计算机随机数字表法,将患者随机分成A组和B组,A组为帕瑞昔布钠组,B组为对照组,每组各40例㊂在麻醉诱导前15min,A组患者静脉注射帕瑞昔布钠40mg,B组患者静脉注射生理盐水5mL㊂1.3㊀观察指标及检测方法㊀㊀在两组患者麻醉诱导前㊁手术结束后2h㊁手术结束后4h㊁手术结束后24h各时点采集静脉血2mL,采用酶联免疫吸附法(Enzyme-linked Immuno Sorbent Assay,ELISA)检测血浆IL-6㊁IL-10㊁TNF-α㊁皮质醇(Cortisol,COR)㊁血管紧张素-II(Angiotensinogen-II, AT-II)含量,采用流式细胞术检测T淋巴细胞亚群(CD3+,CD4+,CD8+)及自然杀伤细胞(Natural Killer Cell,NK)(CD3-,CD16+,CD56+)的百分比㊂记录术后2h,4h,24h,48h两组患者疼痛视觉模拟评分(VAS),48h内舒芬太尼自控镇痛按压次数㊂1.4㊀统计学方法㊀㊀应用SPSS21.0统计软件进行统计分析㊂计量资料以均数ʃ标准差(xʃs)表示,计量资料两组间比较采用t检验㊂计数资料两组间比较采用χ2检验, P<0.05为差异有统计学意义㊂2㊀结果2.1㊀两组患者一般资料分析㊀㊀帕瑞昔布钠组(A组)及对照组(B组)患者一般资料,包括年龄㊁体质量指数㊁手术时间和失血量等方面比较差异均无统计学意义(P<0.05)(见表1)㊂表1㊀两组患者一般情况的比较(xʃs)组别例数/例年龄/岁体质量/kg手术时间/min失血量/mL A组4056.58ʃ5.7962.94ʃ5.58100.42ʃ13.6937.46ʃ9.95 B组4056.40ʃ5.7864.13ʃ4.8598.18ʃ22.8740.44ʃ13.982.2㊀两组患者术后疼痛评分比较㊀㊀A组患者术后2h,4h和24h VAS评分较B组低,差异有统计学意义(P<0.05);两组间48h VAS 评分差异无统计学意义(P>0.05)㊂A组患者术后48h内PCA自控按压次数较B组少,差异有统计学意义(P<0.05)(见表2)㊂表2㊀两组患者术后疼痛评分比较组别例数/例术后2h术后4h术后24h术后48h按压次数/次A组40 1.73ʃ0.75# 2.57ʃ0.43# 1.83ʃ0.54# 1.63ʃ0.59 5.90ʃ2.71# B组40 2.45ʃ0.67 2.95ʃ0.58 2.15ʃ0.36 1.85ʃ0.649.20ʃ3.70注:#为与B组比较,P<0.05㊂2.3㊀两组患者不同时间点炎症因子及应激激素水平的比较㊀㊀术前两组患者血浆IL-6,TNF-α,COR,AT-II水平差异无统计学意义(P>0.05)㊂与术前相比,两组的IL-6,TNF-α,COR,AT-II细胞水平在术后2h, 4h,24h均明显升高,差异有统计学意义(P<0.05)㊂A组在术后2h,4h时点IL-6,TNF-α,COR㊁AT-II 较B组低,差异有统计学意义(P<0.05),两组间在术后24h时点TNF-α,COR,AT-II水平差异无统计学意义(P>0.05)(见表3)㊂2.4㊀两组患者不同时间点T淋巴细胞亚群及NK细胞水平的比较㊀㊀术前两组患者T淋巴细胞亚群及NK细胞分布比例差异无统计学意义(P>0.05)㊂与术前相比,两组的CD3+,CD4+,NK细胞水平在术后4h,24h均明显降低,差异有统计学意义(P<0.05);A组术后4h, 24h时的CD3+,CD4+,CD4+与CD8+比值㊁NK细胞水平高于B组,差异有统计学意义(P<0.05);两组间各时间点CD8+水平比较差异无统计学意义(P>0.05) (见表4)㊂表3㊀两组患者不同时间点炎症因子及应激激素水平的比较(xʃs)组别例数/例时间段IL-6/(pg㊃mL-1)TNF-α/(ng㊃mL-1)COR/(ng㊃mL-1)AT-II/(pg㊃mL-1)A组40术前35.31ʃ7.42 1.46ʃ0.15231.56ʃ32.4753.83ʃ8.96术后2h64.56ʃ10.52∗# 2.55ʃ0.33∗#285.34ʃ34.26∗#70.73ʃ10.74∗#术后4h66.75ʃ11.46∗# 2.59ʃ0.40∗#294.36ʃ21.26∗#79.81ʃ10.16∗#术后24h67.95ʃ8.65∗# 2.63ʃ0.48∗309.11ʃ32.26∗71.93ʃ25.57∗B组40术前34.56ʃ6.93 1.51ʃ0.17238.19ʃ39.1756.39ʃ8.13术后2h69.93ʃ10.73∗ 2.72ʃ0.41∗311.25ʃ45.63∗82.70ʃ15.52∗术后4h73.43ʃ12.63∗ 2.79ʃ0.48∗335.63ʃ37.53∗88.56ʃ12.40∗术后24h72.84ʃ10.73∗ 2.70ʃ0.52∗328.42ʃ46.14∗82.46ʃ28.95∗注:∗为与术前比较,P<0.05;#为与B组比较,P<0.05㊂表4㊀两组患者不同时间点T淋巴细胞亚群及NK细胞的比较(xʃs)组别例数/例时间段CD3+占比/%CD4+占比/%CD8+占比/%CD4+与CD8+比值NK/%A组40术前67.11ʃ6.7142.15ʃ3.0427.99ʃ5.15 1.55ʃ0.2515.55ʃ3.24术后2h64.71ʃ6.7541.09ʃ3.0527.65ʃ4.75 1.52ʃ0.2414.68ʃ3.57术后4h63.17ʃ5.97∗#39.94ʃ4.71∗#27.81ʃ5.26 1.43ʃ0.24∗#12.84ʃ4.07∗#术后24h59.84ʃ6.32∗#38.81ʃ4.80∗#27.58ʃ5.26 1.44ʃ0.21∗#12.04ʃ3.66∗#B组40术前64.83ʃ5.6041.45ʃ4.1427.48ʃ3.97 1.53ʃ0.1714.73ʃ4.41术后2h62.59ʃ5.5340.26ʃ4.2227.32ʃ4.18 1.49ʃ0.1913.53ʃ4.36术后4h59.77ʃ5.60∗37.68ʃ4.65∗27.74ʃ4.49 1.37ʃ0.16∗10.36ʃ4.75∗术后24h56.63ʃ5.40∗36.53ʃ4.48∗28.12ʃ4.53 1.31ʃ0.15∗9.81ʃ2.52∗注:∗为与术前比较,P<0.05;#为与B组比较,P<0.05㊂3㊀讨论㊀㊀2020年世界卫生组织国际癌症研究机构发布的最新数据显示,女性乳腺癌的发病人数已超过肺癌,成为全球最常见的癌症[5]㊂乳腺癌改良根治术是乳腺癌的主要治疗方法之一,由于手术创伤范围广,患者术后急性疼痛发生率超过35%,术后疼痛引起的应激反应可能导致患者免疫功能受到抑制,影响患者预后情况[6]㊂有效的疼痛管理可部分缓解疼痛,降低机体炎症与应激反应,促进患者术后恢复㊂环氧化酶-2(COX-2)是一种位于滑膜细胞㊁内皮细胞和巨噬细胞等炎症组织中的诱导酶,在外界炎症刺激因子的影响下,COX-2的产生可促进炎症介质的合成,诱发炎性疼痛[7]㊂同时COX-2受体广泛存在于外周和中枢神经系统,COX-2也可能使外周和中枢受体敏感,从而引起疼痛㊂因此,COX-2已成为预防炎症和疼痛的常用靶点,非选择性抑制COX-2的非甾体抗炎药常用于围手术期镇痛[8]㊂帕瑞昔布是一种选择性COX-2抑制剂,在肝脏中转化为戊地昔布,因此可以通过抑制前列腺素的合成发挥镇痛作用㊂多项研究已证实帕瑞昔布在不同类型的外科手术围手术期镇痛方面的有效性[9]㊂本研究亦发现,围手术期应用帕瑞昔布可以显著提高术后镇痛效果,与对照组相比舒芬太尼累积消耗量明显降低,术后疼痛评分降低㊂在手术创伤中,巨噬细胞㊁单核细胞可以介导包括IL-6,TNF-α等多种促炎因子的释放,这些因子在疼痛的发生发展中起到重要的作用㊂IL-6,TNF-α对周围神经系统和中枢神经系统有致敏作用,并能刺激COX-2的释放,其升高程度与疼痛密切相关㊂手术创伤及疼痛刺激会引起各种应激激素大量释放进入血液循环,使血液中COR,AT-II等浓度迅速升高㊂本研究结果显示,帕瑞昔布超前镇痛可明显降低术后血浆IL-6,TNF-α,COR,AT-II的水平,两组差异有统计学意义㊂提示帕瑞昔布钠可能通过抑制中枢COX-2的活性,减少前列腺素合成,降低外周和中枢敏感化,发挥镇痛抗炎作用,可有效抑制气管插管应激反应㊂手术应激和疼痛可引起机体免疫功能抑制,改善围手术期细胞免疫状态有助于抵抗免疫抑制,改善肿瘤预后㊂淋巴细胞亚群在细胞免疫反应中起重要作用,NK细胞具有抗肿瘤㊁抗感染和免疫调节作用㊂围手术期监测淋巴细胞亚群和NK细胞活性可反映机体免疫功能[10]㊂CD3+是成熟T淋巴细胞表面标志, CD4+T细胞是辅助性T淋巴细胞,具有抗感染和增强体液免疫应答的作用,CD8+T细胞是抑制/杀伤性T 淋巴细胞,具有特异性直接杀伤性靶细胞的作用㊂机体维持正常免疫功能有赖于T淋巴细胞亚群维持一定的比例,尤其是CD4+与CD8+比值相对稳定,该比值降低表示机体免疫功能降低㊂本研究结果发现,乳腺癌手术患者的CD3+,CD4+T淋巴细胞㊁CD4+与CD8+比值㊁NK细胞的数量在手术4h后显著下降,术后24h下降更为显著,CD8+T淋巴细胞基本不变,提示手术㊁麻醉药物对患者免疫功能有抑制作用;而帕瑞昔布钠组患者术后4h,24h的CD3+,CD4+,CD4+与CD8+比值㊁NK细胞水平均高于对照组,提示帕瑞昔布钠可以减轻疼痛应激㊁麻醉药物对围手术期患者免疫功能的抑制㊂本研究探讨帕瑞昔布钠联合舒芬太尼自控镇痛对乳腺癌改良根治术患者术后疼痛㊁免疫反应及预后的影响㊂结果表明,帕瑞昔布钠联合舒芬太尼对围手术期乳腺癌改良根治术患者可发挥良好的镇痛作用,能够有效抑制手术应激反应,抑制炎症因子及应激激素的水平,并且可以增强乳腺癌改良根治术患者的细胞免疫反应,增强术后镇痛效果㊂参考文献[1]李秋月,许海玉,杨洪军.促炎因子TNF-α,IL-1β,IL-6在神经病理性疼痛中的研究进展[J].中国中药杂志,2017(19):3709-3712.[2]VANDERWALL A G,MILLIGAN E D.Cytokines in pain:harnessing endogenous anti-inflammatory signaling for improved pain management[J].Frontiers in Immunology,2019(10):3009.[3]CHEN J,CONG X F,ZHAN X Z,et al.Effects of Parecoxib on pain threshold and inflammatory factors IL-1β,IL-6and TNF-αin spinal cord of rats with bone cancer pain[J].Journal of the College of Physicians and Surgeons Pakistan,2019(6):528-531.[4]侯彦深,刘玉婷,努尔波拉提㊃加列力汗.帕瑞昔布钠超前镇痛对乳腺癌改良根治术患者术后急性及慢性疼痛的影响[J].新疆医学,2015(3):337-339.[5]SIEGEL R L,MILLER K D,FUCHS H E,et al. Cancer statistics,2021[J].CA:A Cancer Journal for Clinicians,2021(1):7-33.[6]VAN HELMOND N,STEEGERS M A,FILIPPINI-DE MOOR G P,et al.Hyperalgesia and persistent pain after breast cancer surgery:a prospective randomized controlled trial with perioperative COX-2inhibition[J]. PLoS One,2016(12):e0166601.[7]HUANG Z F,MASSEY J B,VIA D P.Differential regulation of cyclooxygenase-2(COX-2)mRNA stability by interleukin-1beta(IL-1beta)and tumor necrosis factor-alpha(TNF-alpha)in human in vitro differentiated macrophages[J].Biochemical Pharmacol-ogy,2000(2):187-194.[8]SUN J Y,SONG Z S,ZHANG X P,et al.Efficacy and safety of COX-2inhibitor Parecoxib for rigid cystoscopy-related pain management in male patients:a prospective,randomized and controlled study[J]. Current Medical Science,2019(1):94-98. [9]ZHU Y,ZHOU C M,YANG Y T,et al.Efficacy of Parecoxib sodium on postoperative shivering:meta-analysis of clinical trials[J].The Journal of International Medical Research,2018(1):3-10. [10]WANG R D,ZHU J Y,ZHU Y,et al. Perioperative analgesia with Parecoxib sodium improves postoperative pain and immune function in patients undergoing hepatectomy for hepatocellular carcinoma [J].Journal of Evaluation in Clinical Practice,2020 (3):992-1000.(编辑㊀何㊀琳)Effect of Parecoxib sodium on inflammatory factors and immune functionin patients undergoing modified radical mastectomyHou Yanshen1Qi Guoqiang2∗1.Department of Anaesthesiology The3rd Affiliated Teaching Hospital of Xinjiang Medical UniversityAffiliated Tumour Hospital Urumqi830011 China2.Department of Anaesthesiology The First People s Hospital of Urumqi Urumqi830011 ChinaAbstract In order to investigate the effects of Parecoxib sodium on postoperative pain inflammatory factors and immune response in patients undergoing modified radical mastectomy 80patients with breast cancer undergoing radical mastectomy were randomly divided into two groups Parecoxib sodium group Group A n=40and control group Group B n=40 .At15min before anesthesia induction patients in the Group A received40mg of Parecoxib sodium intravenously while those in Group B received5mL of normal saline intravenously.Before anesthesia induction 2h after the operation 4h after the operation and24h after the operation 2mL of venous blood was collected from the two groups of patients at each time point.Plasma levels of IL-6 TNF-α COR AT-II were detected by enzymatic linked immunosorbent assay ELISA .The percentages of T lymphocyte subsets CD3+CD4+ CD8+and natural killer cells NK cells CD3-CD16+CD56+were determined by flow cytometry.Visual analogue scale VAS of pain was recorded at2 4 24and48h postoperatively and the times of controlled analgesia were recorded within48h postoperatively.There was no significant difference in VAS score T lymphocyte subsets and NK cell distribution ratio plasma IL-6 TNF-α COR AT-II levels between the two groups before surgery.The VAS scores of Group A were lower than those of Group B at2 4and24h after operation P<0.05 .The number of PCIA compressions within48h after operation in Group A was significantly less than that in Group B P<0.05 .The levels of IL-6 TNF-α COR and AT-II in Group A were lower than those in Group B at2and4h after operation P<0.05 .Compared with the preoperative period the CD3+CD4+ratio of CD4+and CD8+and NK cell levels of the two groups were significantly reduced at4and24h after surgery P<0.05 .The CD3+CD4+ratio of CD4+and CD8+and the level of NK cells in Group A were higher than those in Group B at4and24h after surgery P<0.05 . Parecoxib sodium can decrease the release of inflammatory factors and stress hormones after modified radical mastectomy improve the cellular immune response and enhance the analgesic effect.Key words Parecoxib sodium modified radical mastectomy inflammatory factor immune response。

帕瑞昔布钠超前镇痛对乳腺癌根治术患者心血管反应及术后疼痛的影响于大朋;曹明玉;褚海辰【期刊名称】《广东医学》【年(卷),期】2011(32)3【摘要】目的观察在乳腺癌根治术中, 帕瑞昔布钠超前镇痛对心血管反应及术后疼痛的影响.方法采用随机双盲对照试验设计,ASAⅠ~Ⅱ级择期拟行单侧乳腺癌改良根治术患者50 例, 随机分成两组: P 组(帕瑞昔布钠组) 和C 组(对照组) 各25例; 两组均采用丙泊酚复合芬太尼静脉全麻,在诱导前10 min, P组给予帕瑞昔布钠40 mg 静脉注射作为超前镇痛, C 组则给予等量(4 mL)生理盐水.记录入室后静卧5 min(T0,基础值)、P组静脉注射帕瑞昔布钠及C组注射生理盐水后(T1)、插管前即刻(T2)、手术切皮时(T3)、手术结束时(T4)各时间点的平均动脉压(MAP)、心率(HR)数值,术毕患者恢复情况(苏醒时间﹑拔管时间、清醒时间)及术后0.5、2、4和24 h 疼痛视觉模拟评分(VAS).结果 P组在T3～T4时间点的MAP、HR数值较C组低(P<0.05);P组在术后0.5、2、4和24 h VAS评分较C组低(P<0.05).P组高血压的发生率要明显低于C组;两组患者术毕恢复时间无明显差异.结论帕瑞昔布钠超前镇痛可产生明显的术后镇痛作用,有效抑制手术刺激诱发的心血管反应,降低术后0.5、2、4和24 h VAS评分,不增加术毕苏醒时间.【总页数】3页(P315-317)【作者】于大朋;曹明玉;褚海辰【作者单位】青岛大学医学院附属医院麻醉科,山东青岛,266000;山东省青岛市卫生科技室宣传馆,266000;青岛大学医学院附属医院麻醉科,山东青岛,266000【正文语种】中文【相关文献】1.帕瑞昔布钠与地佐辛超前镇痛对乳腺癌根治术患者心血管反应及术后镇痛的影响[J], 李小刚;周荣胜;王瑞;马正敏;张义长2.帕瑞昔布钠超前镇痛对腹腔镜胆囊切除术患者术后疼痛和应激反应的影响 [J], 王京;温来友;沈永强;黄兵;赵辉;李峰3.帕瑞昔布钠超前镇痛对腹腔镜胆囊切除术后疼痛和应激反应的影响 [J], 文伟名4.帕瑞昔布钠超前镇痛对开胸手术患者全麻苏醒期躁动及心血管反应的影响 [J], 刘晓峰;于晋健;王额尔敦;郑永顺;王歆5.帕瑞昔布钠超前镇痛对老年髋部骨折术后疼痛和应激反应影响 [J], 王雨辰;俞伟忠因版权原因，仅展示原文概要，查看原文内容请购买。