帕瑞昔布钠超前镇痛对胃癌根治术患者围术期Th1/Th2平衡的影响

中国临床药理学与治疗学 ›› 2010, Vol. 15 ›› Issue (6): 686-690.

帕瑞昔布钠超前镇痛对胃癌根治术患者围术期Th1/Th2平衡的影响

陈忠华, 蒋宗明, 楼静芝, 郑羡河, 张昌锋, 胡双燕, 樊菊美

浙江绍兴市人民医院麻醉科,绍兴 312000,浙江

收稿日期:2010-03-08 修回日期:2010-04-09 出版日期:2010-06-26 发布日期:2020-09-16
作者简介:陈忠华,男,硕士,副主任医师,研究方向:临床麻醉与危重病医学。Tel: 13625751526 E-mail:qcma@zeldawear.com

Influence of preemptive analgesia with parecoxib sodium on the balance of Th1/Th2 during radical resection of gastric carcinoma

CHEN Zhong-hua, JIANG Zong-ming, LOU Jing-zhi, ZHENG Xian-he,ZHANG Chang-feng, HU Shuang-yan, FANG Ju-mei

Department of Anesthesiology, Zhejiang Shaoxing People's Hospital, Shaoxing 312000, Zhejiang, China

Received:2010-03-08 Revised:2010-04-09 Online:2010-06-26 Published:2020-09-16

摘要/Abstract

摘要： 目的: 研究帕瑞昔布钠超前镇痛对胃癌根治术患者围术期Th细胞漂移的影响。方法: 40例择期全麻下行胃癌根治术患者随机分为两组,Ⅰ组患者麻醉前 30 min 静脉给予帕瑞昔布钠 40 mg(稀释为 5 mL);Ⅱ组麻醉前 30 min 静脉给予生理盐水 5 mL。两组患者手术结束前 10 min 静脉给予帕瑞昔布钠 40 mg(稀释为 5 mL)后均接PCIA泵给予芬太尼镇痛。两组PCIA药物为芬太尼 10 μg/kg,用生理盐水稀释为 100 mL,输注速率 2 mL/h,PCIA剂量 0.5 mL,锁定时间 15 min。于麻醉前(T₁)、术毕(T₂)、术后24 h(T₃)、72 h(T₄)抽取外周血,测定血浆皮质醇(Cor)、干扰素-γ(IFN-γ)、白细胞介素-4(IL-4)浓度。结果: 与T₁时比较,Ⅱ组T₂、T₃时Cor 升高,Ⅰ组Cor 仅在T₂时升高(P﹤0.05)。与Ⅱ组比较,Ⅰ组T₂、T₃时Cor明显降低(P﹤0.05)。Ⅰ组T₃时IL-4低于T₁ (P﹤0.05)。与Ⅱ组比较,Ⅰ组T₄时IL-4明显降低(P﹤0.05)。与T₁比较,两组T₂、T₃、T₄时IFN-γ明显上升(P﹤0.05)。Ⅰ组T₂、T₃时IFN-γ明显高于Ⅱ组(P﹤0.05)。与T₁时比较,两组T₂、T₃、T₄时IFN-γ/ IL-4均升高(P﹤0.05);Ⅰ组T₃时IFN-γ/ IL-4明显高于Ⅱ组(P﹤0.05)。结论: 帕瑞昔布钠超前镇痛能减轻胃癌患者手术后Th1/Th2平衡的漂移程度,改善机体手术创伤后免疫受抑状态。

关键词: 帕瑞昔布钠, 超前镇痛, 干扰素-γ, 白细胞介素-4

Abstract: AIM: To determine the effect of preemptive analgesia with parecoxib sodium on balance of Th1/Th2 during radical resection of gastric carcinoma. METHODS: Fourty patients scheduled for radical resection of gastric carcinoma under general anesthesia were randomly allocated into groupⅠand groupⅡwith 20 cases each. Parecoxib sodium 40 mg was intravenously administered 30 minutes before anesthesia induction in groupⅠ, while in groupⅡ normal saline 5 mL was injected via vein route 30 minutes before anesthesia induction. All patients received intravenous injection of parecoxib sodium 40 mg 10 min before the end of operation and then were attached to a PCIA pump. PCIA with fentanyl 10 μg/kg was added into normal saline 100 mL in two groups. The infusion rate was 2 mL/h, bolus dose was 0.5 mL,lockout interval was 15 min. The plasma concentrations of cortisol, interferon-γ(INF-γ) and interleukin-4(IL-4) were measured before induction of anesthesia(T₁), at the end of operation(T₂), at 24h(T₃) and 72 h(T₄)after operation. RESULTS: Compared with T₁,Cor was higher at T₂ and T₃ in groupⅡand at T₃ in groupⅠ(P＜0.05). Cor levels at T₂ and T₃ were lower in groupⅠthan those in groupⅡ(P＜0.05).IL-4 of groupⅠwas lower at T₃ than that at T₁ (P＜0.05). IL-4 at T₄ was lower in groupⅠthan that in groupⅡ(P＜0.05). INF-γof groupⅠwas higher at T₂,T₃ and T₄ than those at T₁ (P＜0.05), which was higher at T₂ and T₃ than those of groupⅡ(P＜0.05).The ratio of IFN-γ/IL-4 in both groups was significantly higher at T₂,T₃ and T₄ than those at T₁, which at T₃ was higher in groupⅠ than that in groupⅡ(P＜0.05). CONCLUSION: Preemptive analgesia with parecoxib sodium can alleviate the excursion degree of Th1/Th2 and improve immunological suppression after radical resection of gastric carcinoma.

Key words: Parecoxib sodium, Preemptive analgesia, Interferon-γ, Interleukin-4

中图分类号:

R614

陈忠华, 蒋宗明, 楼静芝, 郑羡河, 张昌锋, 胡双燕, 樊菊美. 帕瑞昔布钠超前镇痛对胃癌根治术患者围术期Th1/Th2平衡的影响[J]. 中国临床药理学与治疗学, 2010, 15(6): 686-690.

CHEN Zhong-hua, JIANG Zong-ming, LOU Jing-zhi, ZHENG Xian-he,ZHANG Chang-feng, HU Shuang-yan, FANG Ju-mei. Influence of preemptive analgesia with parecoxib sodium on the balance of Th1/Th2 during radical resection of gastric carcinoma[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2010, 15(6): 686-690.

参考文献

[1] Wang K, Wu H, Wang G, et al. The effects of electroacupuncture on the Th1/Th2 cytokine mRNA expression and mitogen-activated protein kinase signaling pathways in the splenic T cells of traumatized rats[J]. Anesth Analg, 2009,109(5):1666-1673.
[2] 聂汉祥,郭卫,扬炯.小剂量茶碱对原始T淋巴细胞分化的影响[J].中国临床药理学与治疗学,2004,9(11):1293-1296.
[3] 吕小华,吴铁,覃冬云.甘草对慢性小鼠哮喘模型气道炎症及外周血Th1/Th2失衡的影响[J].中国临床药理学与治疗学,2006,11(5):532-534.
[4] 李斌,文亮,刘明华,等.创伤患者血浆干扰素-γ、白介素-4动态变化及其意义[J].创伤外科杂志,2004,6(4):266-268.
[5] 辜晓岚,徐建国.超前镇痛的机制及其研究进展[J].医学研究生学报,2008,21(1):99-103.
[6] Zou W, Guo Q, Wang E, et al. Intrathecal morphine suppresses immune function in rats with inflammatory-induced pain[J]. Int Med Res, 2007,35(5):626-636.
[7] 杜权,葛衡江,朱佩芳.围术期镇痛对术后炎症反应的影响[J].国际麻醉学与复苏杂志,2007,28(1):48-50.
[8] Fornai M,Colucci R, Graziani F, et al. Cyclooxygenase-2 induction after oral surgery does not entirely account for analgesia after selective blockade of cyclooxygenase 2 in the preoperative period[J]. Anesthesiology, 2006,104(1):152-157.
[9] 崔向丽,赵志刚,陈丽,等.新型注射用选择性COX-2抑制剂帕瑞昔布钠[J].中国新药杂志,2009,18(14):1283-1286.
[10] Soltesz S, Gerbershagen MU, Pantke B, et al. Parecoxib versus dipyrone(metamizole) for postoperative pain relief after hysterectomy: a prospective, single-centre, randomized, double-blind trail[J]. Clin Drug Investig, 2008,28(7):421-428.
[11] 吴新民,岳云,张利萍,等.术后镇痛中帕瑞昔布钠对吗啡用量的节俭作用和安全性－前瞻性、多中心、随机、双盲、安慰剂对照、平行分组研究[J].中华麻醉学杂志,2007,27(1):7-10.
[12] 王红梅,周海燕.硬膜外超前镇痛对上腹部手术病人应激反应的影响[J]. 中华麻醉学杂志,2009,29(9):777-779.
[13] Inada T, Yamanouchi Y, Jomura S, et al. Effect of propofol and isoflurane anesthesia on the immune response to surgery[J]. Anaesthesia,2004,59(10):954-959.