帕瑞昔布钠联合镇痛对乳腺癌患者术后炎症及应激反应的影响

摘要

目的 探讨帕瑞昔布钠联合镇痛对乳腺癌患者术后炎症和应激反应的影响.方法 择期在全麻下行乳腺癌根治术患者60例,随机分为帕瑞昔布钠联合镇痛组(P组)和对照组(C组),每组30例.两组术后均采用布托啡诺行自控静脉镇痛.分别于术毕即刻、术后12、24、36 h静注帕瑞昔布钠40 mg(P组)和生理盐水5ml(C组).用放免法测定血浆前列腺素E2(PGE2)、肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6及肾素、血管紧张素-Ⅱ(ANG-Ⅱ)、醛固酮(ALD)、皮质醇(Cor)浓度.结果 术后12～48 h,P组血浆PGE2、TNF-α、IL-6及肾素、ANG-Ⅱ、ALD、Cor浓度无明显变化,但在术后12、24 h明显低于C组(P＜0.05).结论 帕瑞昔布钠联合布托啡诺镇痛可减轻乳腺癌根治术患者术后的炎症反应和应激反应,有一定的免疫保护作用.%Objective To investigate the effects of parecoxib combined with analgesia on inflammatory response and stress response in patients after radical excision of breast cancer. Methods Sixty breast cancer patients with ASA Ⅰ orⅡ undergoing radical excision of breast cancer were selected and randomly divided into 2 groups: parecoxib combined analgesia group (group P, n= 30) and control group (group C, n = 30). All patients received intravenous analgesia (PCIA) with butorphanol. In group P, 40 mg parecoxib was administered at the end of the surgery and 12, 24 h and 36 h after surgery, respectively; group C received iv saline 5 ml at the same time points. PGE2, TNF-a, IL-6, renin activity, angiotensin Ⅱ, aldosterone and cortisol in plasma in each group were measured. Results There was no significant difference in the concentrations of plasma PGE2, TNF-a, IL-6. renin activity, angiotensin Ⅱ, aldosterone and cortisol at 12 h, 24 h, 48 h postoperatively compared to before anesthesia in group P, while the concentrations at 12 h and 24 h postoperatively were significantly increased compared in group C(P<0. 05). The concentrations of plasma PGE2, TNF-a, IL-6, renin activity, angiotensin Ⅱ , aldosterone and cortisol at 12 h and 24 h postoperatively were significantly lower in group P than in group C (P<0. 05). Conclusion Parecoxib analgesia combined with butorphanol can relieve inflammatory response and stress response. It has protective effect on immune system in the patients after radical excision of breast cancer.