目的

研究帕瑞昔布钠对乳腺癌改良根治术患者术后镇痛效果和应激反应的影响。

方法

根据美国麻醉师协会(ASA)分级,选择ASAⅠ～Ⅱ级择期行全麻下乳腺癌改良根治术患者60例,随机分为帕瑞昔布钠组和对照组。两组均采用布托啡诺行自控静脉镇痛,帕瑞昔布钠组于术毕即刻、术后12、24、36 h分别静脉注射帕瑞昔布钠40 mg;对照组在各时点给予生理盐水5 ml。于麻醉前(T0)、术后2 h(T1)、12 h(T2)、24 h(T3)、48 h(T4)抽静脉血,用放免法测定血浆肾素、血管紧张素Ⅱ、醛固酮、皮质醇浓度,于T1到T4点记录视觉模拟镇痛评分(visual analogue scale,VAS).采用t检验和重复测量方差分析法进行统计学分析。

结果

帕瑞昔布钠组VAS 于T2、T3、T4时明显低于对照组(P＜0.05);帕瑞昔布钠组血浆肾素、血管紧张素Ⅱ、醛固酮、皮质醇浓度于T2、T3、T4时与T0比较差异无统计学意义(P＞0.05),而对照组各指标T2、T3较T0明显增高(P＜0.05);帕瑞昔布钠组与对照组比较各相指标在T2、T3显著降低(P＜0.05)。

结论

联合应用帕瑞昔布钠术后镇痛效果完善,并可抑制术后机体应激反应,对于缓解乳腺癌根治患者术后免疫损伤和炎症反应有一定帮助。

Objective

To investigate theinfluence of parecoxib on analgesic effect and stress responsein breast cancer patients treated with modified radical mastectomy.

Methods

According to American Society of Anesthesiologists(ASA)grade,60 breast cancer patients with ASAⅠorⅡundergoing modified radical mastectomy were selected and randomly divided into 2 groups:the parecoxib group(n=30)and the control group(n=30).All patients received intravenous analgesia(PCIA)with butorphanol.In the parecoxib group,40 mg parecoxib was ad ministered at the end of the surgery and 12 h,24 h and 36 h after surgery.The control group received iv saline 5 ml at the same ti me points.Renin activity,angiotensinⅡ,aldosterone and cortisol in plas ma in each group were measured i mmediately before induction of anesthesia(T0)and 2 h(T1),12 h(T2),24 h(T3)and 48 h(T4)after operation.The analgesic effect assessed by visual analog scale(VAS)at T1,T2,T3 and T4.Repeated measures analysis of variance and t test were used for statistical analysis.

Results

The VAS pain scores in the parecoxib group were significantly lower than those in the control group at T2,T3 and T4,respectively(P＜0.05).There was no significant difference in the concentrations of plas ma renin activity,angiotensinⅡ,aldosterone and cortisol at T2,T3,and T4 compared to T0 in the parecoxib group(P＞0.05),while the concentrations of plasma renin activity,angiotensinⅡ,aldosterone and cortisol at T2,T3 were significantly increased compared to T0 in the control group (P＜0.05).The concentrations of plas ma renin activity,angiotensinⅡ,aldosterone and cortisol at T2 and T3 were significantly lower in the parecoxib group than in the control group,with statistical difference bet ween the t wo groups (P＜0.05).

Conclusion

Parecoxib has a good postoperation analgesic effect,and can effectively prevent stress response.It is useful in relieving postoperative i mmunolesion and inflammatory reaction for breast cancer patients with radical excision of breast cancer.