国际麻醉学与复苏杂志   2010, Issue (2): 99-102
    
氟比洛芬酯术后镇痛对血浆皮质醇、 白细胞介素 10 和肿瘤坏死因子α的影响
洪彬源 刘洪珍 杨承祥 梁幸甜 邓硕曾1()
1.528000 佛山市第一人民医院麻醉科
Effect of flurbiprofen axetil on blood plasma levels of cortisol, interleukin 10 and tumor necrosis factor αin patient-controlled intravenous analgesia post-operation.
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摘要：

目的　观察氟比洛芬酯用于髋关节置换术后患者静脉自控镇痛(Patient-controlled intravenous analgesia, PCIA)的临床效果及其对机体血浆皮质醇(cortisol, Cor)、白细胞介素10(interleukin 10, IL-10)和肿瘤坏死因子α(tumor necrosis factor α,TNF-α)的影响。方法　选择40例单侧髋关节置换术患者，ASAⅠ级～Ⅱ级，按抽签方法随机分为两组，每组20例，Ⅰ组为枸橼酸芬太尼1.2 mg/24 ml+0.9%生理盐水76 ml，负荷量为枸橼酸芬太尼0.001 mg/kg；Ⅱ组为氟比洛芬酯300 mg/30 ml+0.9%生理盐水70 ml，负荷量为氟比洛芬酯1 mg/kg。分别于麻醉前(T1)、术后第4 h(T2)、24 h(T3)、36 h(T4)和48 h(T5)5个时点抽取静脉血测定血浆Cor、IL-10和TNF-α浓度，于术后4、24、36、48 h用视觉模拟评分法(visual analogue scales, VAS)行静止和活动评分，均由同一麻醉医生在不知道到具体镇痛方式情况下进行。 结果 术后各时点VAS 评分两组间比较差异无统计学意义(P>0.05)，但Ⅰ组尿潴 留、恶心和呕吐发生率40%高于Ⅱ组(P<0.01)。 两组在T2时血浆Cor值(275±28.6 μg/L和276±30.5 μg/L)均升高，与T1 (203.5±22.3 μg/L和192.3±21.3 ng/ml)比较差异有统计学意义(P<0.01)，Ⅰ组在T3时血浆Cor水平(256±28.3 ng/ml)仍明显高于T1值(203.5±22.3 μg/L) (P<0.05)，在T3(256±28.3 μg/L)和T4(235±23.3 μg/L)时均高于Ⅱ组水平(176±22.3 μg/L和172±20.5 μg/L)(P<0.05)；两组T3 (60.23±3.65 ng/L和62.35±5.02 ng/L)和T4(60.12±3.31 ng/L和61.34±4.23 ng/L)时血浆IL-10 水平均高于T1值(55.32±2.61 ng/L和 55.65±2.53 ng/L) (P<0.05)，组间比较差异无统计学意义(P>0.05)；Ⅱ组在T3、T4 和T5时血浆TNF-α浓度(52.56±4.31ng/L, 58.42±5.64 ng/L和 59.53±6.02 ng/L)均比T1 (43.31±1.52 ng/L)明显升高(P<0.01)，同时明显高于Ⅰ组(45.12±2.32 ng/L, 42.23±2.21 ng/L和42.52±2.35ng/L)(P<0.01) 结论　髋关节置换术患者术后行PCIA，氟比洛芬酯与芬太尼的镇痛效果相似，副作用明显减少，且在一定程度上改善机体免疫力。
关键词： 氟比洛芬酯； 细胞因子； 患者静脉自控镇痛； 枸橼酸芬太尼
Abstract:

Objective To investigate the clinical effect of post-operative flurbiprofen axetil analgesia and the influence on plasma levels of cortisol，IL-10 and TNF-αin patients undergoing hip replacement. Methods Forty patients undergoing single hip replacement were randomly divided into two groups（n = 20）.Patientsreceived intravenousfentanyl（groupI）orflurbiprofen axetil（groupⅡ）analgesia after surgery. Pain VAS and plasma levels of cortisol，IL-10 and TNF-αwere tested and detected，respectively. Results There was no difference in the VAS scores ofT2，T3，T4 andT5（P>0.05）, but the incidence ratesofretention ofurine, nausea and vomiting 40% were higher in groupⅠthan groupⅡ（P<0.01）. Blood plasma levels ofCor（275±28.6）ng/L and（276±30.5）ng/L increased atT2 in the two groups, and there was obviously significant difference by comparedT2withT（1 203.5±22.3）ng/L and（192.3±21.3）ng/L（P<0.01）. The levels of Cor in groupⅠwere higher atT（3 256±28.3）ng/L than atT（1 203.5±22.3）ng/ml, and higher than that in group Ⅱ atT3 （256±28.3）ng/L andT4（235±23.3）ng/L（P<0.05）. The levels of IL-10 were obviously higher atT3 （60.23±3.65）ng/L and（62.35±5.02）ng/L、T4（60.12±3.31）ng/L and（61.34±4.23）ng/L than atT（1 55.32±2.61）ng/L and（55.65±2.53）ng/L，but there was no difference between the two groups. The levels of TNF-α were higher atT（3 52.56±4.31）ng/L、T（4 58.42±5.64）ng/L、T5（59.53±6.02）ng/L than atT（1 43.31±1.52）ng/L in group Ⅱ（P<0.01），and obviously higher atT3、T4、T5 in groupⅡthan group Ⅰ（P<0.01）. Conclusion Intravenous flurbiprofen exerts similar post-operative analgesia effect to fentanyl in patients undergoing hip replacement，with less adverseeffects and betterimprovementoforganism immunity.
Key words: Flurbiprofen axetil；Cell factor；Post-operative analgesia；Fentanyl citrate