摘要
目的探讨腹部闭合性损伤全麻开腹手术患者予帕瑞昔布钠超前镇痛的镇痛效果及对疼痛介质、T淋巴细胞免疫功能、应激反应的影响。方法选取2017年1月-2019年1月在本院接受全麻开腹手术的腹部闭合性损伤患者80例,应用随机数字表法分为观察组和对照组各40例。观察组于手术结束前10 min静脉滴注帕瑞昔布钠40 mg,对照组静脉滴注等量0.9%氯化钠注射液;2组均于停止麻醉药物输注后接自控静脉镇痛泵。对比2组麻醉诱导前(T0)、术后6 h(T1)、术后12 h(T2)、术后24 h(T3)Prince-Hbenry疼痛评分法评分,血清疼痛介质、T淋巴细胞免疫指标、应激激素水平差异。结果观察组T1、T2时Prince-Hbenry疼痛评分显著低于对照组(P<0.01);T1、T2时观察组血清前列腺素E2、5-羟色胺、神经肽Y、P物质较对照组低(P<0.05或P<0.01);T1、T2、T3时观察组T淋巴细胞CD3+、CD4+、CD4+/CD8+显著高于对照组,CD8+显著低于对照组,差异有统计学意义(P<0.05或P<0.01);T1、T2时观察组皮质醇、去甲肾上腺素、肾上腺素水平显著低于对照组(P<0.05或P<0.01)。结论帕瑞昔布钠超前镇痛用于腹部闭合性损伤患者术后镇痛效果良好,可有效减轻患者主观疼痛感受,抑制疼痛介质释放,保护免疫功能,减轻应激反应。
Objective To investigate the analgesic effect of preemptive analgesia with parecoxib sodium and its effect on pain mediators, T lymphocyte immunity and stress response in patients undergoing abdominal closure injury under general anesthesia. Methods From January 2017 to January 2019, 80 patients with abdominal closed injury who underwent laparotomy under general anesthesia in our hospital were enrolled in this study. They were randomly divided into control group and observation group, with 40 patients in each group according to random number table method. The observation group was intravenously injected with 40 mg of parecoxib sodium at 10 min before end of the operation, while the control group was intravenously injected with the same amount of 0.9% sodium chloride. All patients in the two groups were connected to the automatic intravenous analgesia pump after infusion of anesthetic drugs was withdrawn. The differences in pain scores, serum pain mediators, T lymphocyte immune indicators and stress hormone levels of two groups were compared before anaesthesia induction(T0), at 6 h after operation(T1), 12 h after operation(T2) and 24 h after operation(T3). Results At T1 and T2, Prince-Hbenry pain scores in the observation group were significantly lower than those in the control group(P<0.01). The levels of prostaglandin E2, 5-HT, neuropeptide Y(NPY) and substance P(SP) in serum of the observation group were lower than those of the control group at T1 and T2(P<0.05 or P<0.01). CD3+, CD4+, CD4+/CD8+ levels of T lymphocytes at T1, T2 and T3 were significantly higher than those in the control group, while CD8+ levels were significantly lower than those in the control group(P<0.05 or P<0.01). Conclusion Preemptive analgesia with parecoxib sodium has a good effect for postoperative analgesia in patients with abdominal closure injury, which can effectively reduce subjective pain perception of patients, inhibit the release of pain mediators, protect immunity of patients and suppress stress response.
作者
张金立
肖芳
闫红丽
张艺璇
杨凯
王鹏
ZHANG Jin-li;XIAO Fang;YAN Hong-li;ZHANG Yi-xuan;YANG Kai;WANG Peng(Department of Anesthesiology,the First Central Hospital of Baoding,Baoding,Hebei 071051,China;Department of Emergency,the First Central Hospital of Baoding,Baoding,Hebei 071051,China;Department of Anesthesiology,Maternal and Child Health Hospital of Baoding,Baoding,Hebei 071051,China;Department of Scientific Research,Affiliated Hospital of Hebei University,Baoding,Hebei 071000,China;Clinical Medicine Class 2016,Xinxiang Medical University,Xinxiang,Henan 453000,China)
出处
《临床误诊误治》
2020年第7期93-98,共6页
Clinical Misdiagnosis & Mistherapy
基金
保定市科学技术研究与发展指导计划(18ZF211)
河北省2017年度医学科学研究重点课题(20170831)。
作者简介
通讯作者:肖芳,E-mail:2697620035@qq.com。
