帕瑞昔布钠用于结直肠癌根治术多模式镇痛对患者疼痛和免疫抑制的影响
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摘要
目的研究帕瑞昔布钠用于结直肠癌根治术多模式镇痛对患者疼痛和免疫抑制的影响。方法纳入2014年3月至2017年3月我院80例接受结直肠癌根治术患者作为研究对象,随机抽签分为两组,各40例。观察组麻醉诱导时加用帕瑞昔布钠,术后行自控静脉镇痛(PCIA),对照组行单纯PCIA。比较两组手术基本情况、镇痛效果、免疫功能及吗啡用量,分析止痛效果与免疫抑制的关系。结果两组手术时间和术中出血量均无显著性差异(P>0.05),观察组住院时间、术后首次排气和排便时间较对照组显著缩短(P<0.05)。两组术后12 h和24 h时CD3+、CD4+及CD4+/CD8+均显著低于术前(P<0.05),观察组术后12 h、24 h及48 h时CD3+、CD4+及CD4+/CD8+均显著高于对照组(P<0.05),术后48 h和出院时观察组CD4+、CD8+及CD4+/CD8+与术前比较无显著性差异(P> 0.05)。两组患者术后48 h时VAS评分与CD4+/CD8+水平呈显著负相关性(r=-0.8373,P=0.000)。观察组术后平均吗啡用量显著低于对照组(P<0.05)。结论帕瑞昔布钠用于结直肠癌根治术多模式镇痛有助于提高止痛效果,改善免疫抑制作用,且能促进术后胃肠功能的早期恢复。
Objective To study the effect of parecoxib sodium on pain and immunosuppression in patients with radical resection of colorectal cancer. Methods 80 patients from March 2014 to March 2017 in our hospital with radical resection of colorectal cancer were randomly divided into two groups, 40 cases in each group. The patients in the observation group received parecoxib sodium during anesthesia induction and the patient-controlled intravenous analgesia( PCIA) was performed after operation, and the control group received patients-controlled intravenous analgesia( PCIA).The operation condition,analgesic effect,immune function and the dosage of morphine were compared between the two groups. The relationship between analgesic effect and immunosuppression was analyzed.Results There were no significant difference between the two groups in operation time and intraoperative blood loss( P > 0. 05),the hospitalization time,the first postoperative exhaust and defecation time of the observation group were significantly shorter than those of the control group( P<0.05). The CD3+,CD4+and CD4+/CD8+of the two groups after operation in 12 and 24 hous were significantly lower than those before operation( P<0.05),the levels of CD3+,CD4+and CD4+/CD8+in the observation group after operation in 12,24 and 48 hours were significantly higher than those in the control group( P<0.05),there were no significant difference of CD4+,CD8+and CD4+/CD8+between at discharge and after operation in 48 hours and preoperative in the observation group( P > 0. 05). There was a significantly negative correlation between VAS score after operation in 48 hours and CD4+/CD8+levels in the two groups patients( r =-0.8373,P = 0.000). The average morphine consumption in the observation group was significantly lower than that in the control group( P<0.05).Conclusion The multimodal analgesia with parecoxib sodium in radical resection of colorectal cancer can improve the analgesic effect,and it can promote the early recovery of gastrointestinal function after colorectal cancer surgery.
Objective To study the effect of parecoxib sodium on pain and immunosuppression in patients with radical resection of colorectal cancer. Methods 80 patients from March 2014 to March 2017 in our hospital with radical resection of colorectal cancer were randomly divided into two groups, 40 cases in each group. The patients in the observation group received parecoxib sodium during anesthesia induction and the patient-controlled intravenous analgesia( PCIA) was performed after operation, and the control group received patients-controlled intravenous analgesia( PCIA).The operation condition,analgesic effect,immune function and the dosage of morphine were compared between the two groups. The relationship between analgesic effect and immunosuppression was analyzed.Results There were no significant difference between the two groups in operation time and intraoperative blood loss( P > 0. 05),the hospitalization time,the first postoperative exhaust and defecation time of the observation group were significantly shorter than those of the control group( P<0.05). The CD3+,CD4+and CD4+/CD8+of the two groups after operation in 12 and 24 hous were significantly lower than those before operation( P<0.05),the levels of CD3+,CD4+and CD4+/CD8+in the observation group after operation in 12,24 and 48 hours were significantly higher than those in the control group( P<0.05),there were no significant difference of CD4+,CD8+and CD4+/CD8+between at discharge and after operation in 48 hours and preoperative in the observation group( P > 0. 05). There was a significantly negative correlation between VAS score after operation in 48 hours and CD4+/CD8+levels in the two groups patients( r =-0.8373,P = 0.000). The average morphine consumption in the observation group was significantly lower than that in the control group( P<0.05).Conclusion The multimodal analgesia with parecoxib sodium in radical resection of colorectal cancer can improve the analgesic effect,and it can promote the early recovery of gastrointestinal function after colorectal cancer surgery.
引文
[1]蔡楚东,周俊怿,方喜.腹腔镜微创根治术对结直肠癌患者疼痛及免疫功能的影响[J].广东医学,2017,38(15):2350-2352.
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[6]严广斌.视觉模拟评分法[J].中华关节外科杂志(电子版),2014,8(2):34-34.
[7]刘维帅,邵月娟,王昆.癌性神经病理性疼痛的发病机制、临床评估及治疗[J].国际肿瘤学杂志,2015,42(12):946-949.
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[9]董克军,隋世华,赵涛,等.鞘内注射吗啡治疗直肠癌重度癌性疼痛的疗效分析[J].中华神经医学杂志,2016,15(8):835-838.
[10]李桥波,舒海华,叶芳,等.不同剂量喷他佐辛抑制吗啡的镇痛作用[J].中国疼痛医学杂志,2016,22(2):102-108.
[11]Qiu S,Feng Y,Lesage G,et al. Chronic morphine-induced Micro RNA-124 promotes microglial immunosuppression by modulating P65 andTRAF6[J].J Immunol,2015,194(3):1021-1030.
[12]廖美娟,郑雪琴,冯舒韵,等.羟考酮与吗啡术后镇痛对结肠癌根治术患者血小板活性和细胞免疫功能的影响[J].临床麻醉学杂志,2017,33(6):542-545.
[13]杨淋.帕瑞昔布钠与舒芬太尼用于无痛胃镜麻醉的有效性与安全性分析[J].现代消化及介入诊疗,2015,20(5):507-508.
[14]刘卫锋,刘克玄,赵国栋,等.帕瑞昔布钠联合硬膜外吗啡用于妇科手术病人多模式术后镇痛的效果:随机、双盲、安慰剂对照、多中心、前瞻性研究[J].中华麻醉学杂志,2012,32(11):1293-1296.
[15]龚拯,栗俊,梁宁,等.超前镇痛对老年结直肠肿瘤腹腔镜手术快通道麻醉后复苏质量的影响[J].广西医学,2013,35(10):1324-1326.
[16]洪彬源,陈桂纯,王云花,等.多模式麻醉药物合用对结肠癌根治术患者免疫功能的影响[J].广东医学,2016,37(20):3080-3083.
[17]姚依勍,朱惠蓉,张怡,等.加味肠益方对湿热兼瘀型结直肠癌术后患者VEGF及COX-2的影响[J].辽宁中医杂志,2015,42(9):1677-1679.
[18]Li Y,Jia H,Yu W,et al. Nomograms for predicting prognostic valueof inflammatory biomarkers in colorectal cancer patients afterradical resection[J].Int J Cancer,2016,139(1):220.
[19]徐珂嘉,苏喆,钱刚,等.基于快速康复外科理论的多模式镇痛在腹腔镜结直肠癌根治术中的应用[J].山东医药,2016,56(10):38-39.
[20]张雪,张宏志,李明强,等.地佐辛和吗啡对胃肠道肿瘤患者术中免疫功能的影响[J].中国医院药学杂志,2015,35(17):1591-1594.
[21]李莎莎,刘爱秀,曹淑梅,等.老年腹腔镜结直肠癌根治术患者采取多模式镇痛的效果观察[J].结直肠肛门外科,2016,22(6):647-650.
[2]李贵新,刘锦,李肖燕,等.结肠癌患者术后化疗联合自体级联诱发免疫细胞治疗近期疗效和生活质量观察[J].中华肿瘤防治杂志,2014,21(19):1548-1552.
[3]Sc W,Ayman A,Dina N,et al. Effect of multimodal analgesia versuscaudal analgesia on intraoperative surgical stress responses andanalgesia in pediatric cancer patients[J]. Eur Urol,2015,41(6):677-685.
[4]朱剑宇,荚卫东,许戈良,等.帕瑞昔布钠联合芬太尼多模式镇痛对原发性肝癌患者围术期免疫功能的影响[J].中华普通外科杂志,2016,31(2):117-120.
[5]邱爽,董有静,段丽芳.帕瑞昔布钠超前镇痛联合舒芬太尼术后镇痛对老年患者术后早期认知功能的影响[J].实用药物与临床,2016,19(4):425-429.
[6]严广斌.视觉模拟评分法[J].中华关节外科杂志(电子版),2014,8(2):34-34.
[7]刘维帅,邵月娟,王昆.癌性神经病理性疼痛的发病机制、临床评估及治疗[J].国际肿瘤学杂志,2015,42(12):946-949.
[8]Vincent L,Vang D,Nguten J,et al. Mast cell activation contributes tosickle cell pathobiology and pain in mice[J]. Blood,2013,122(11):1853-1862.
[9]董克军,隋世华,赵涛,等.鞘内注射吗啡治疗直肠癌重度癌性疼痛的疗效分析[J].中华神经医学杂志,2016,15(8):835-838.
[10]李桥波,舒海华,叶芳,等.不同剂量喷他佐辛抑制吗啡的镇痛作用[J].中国疼痛医学杂志,2016,22(2):102-108.
[11]Qiu S,Feng Y,Lesage G,et al. Chronic morphine-induced Micro RNA-124 promotes microglial immunosuppression by modulating P65 andTRAF6[J].J Immunol,2015,194(3):1021-1030.
[12]廖美娟,郑雪琴,冯舒韵,等.羟考酮与吗啡术后镇痛对结肠癌根治术患者血小板活性和细胞免疫功能的影响[J].临床麻醉学杂志,2017,33(6):542-545.
[13]杨淋.帕瑞昔布钠与舒芬太尼用于无痛胃镜麻醉的有效性与安全性分析[J].现代消化及介入诊疗,2015,20(5):507-508.
[14]刘卫锋,刘克玄,赵国栋,等.帕瑞昔布钠联合硬膜外吗啡用于妇科手术病人多模式术后镇痛的效果:随机、双盲、安慰剂对照、多中心、前瞻性研究[J].中华麻醉学杂志,2012,32(11):1293-1296.
[15]龚拯,栗俊,梁宁,等.超前镇痛对老年结直肠肿瘤腹腔镜手术快通道麻醉后复苏质量的影响[J].广西医学,2013,35(10):1324-1326.
[16]洪彬源,陈桂纯,王云花,等.多模式麻醉药物合用对结肠癌根治术患者免疫功能的影响[J].广东医学,2016,37(20):3080-3083.
[17]姚依勍,朱惠蓉,张怡,等.加味肠益方对湿热兼瘀型结直肠癌术后患者VEGF及COX-2的影响[J].辽宁中医杂志,2015,42(9):1677-1679.
[18]Li Y,Jia H,Yu W,et al. Nomograms for predicting prognostic valueof inflammatory biomarkers in colorectal cancer patients afterradical resection[J].Int J Cancer,2016,139(1):220.
[19]徐珂嘉,苏喆,钱刚,等.基于快速康复外科理论的多模式镇痛在腹腔镜结直肠癌根治术中的应用[J].山东医药,2016,56(10):38-39.
[20]张雪,张宏志,李明强,等.地佐辛和吗啡对胃肠道肿瘤患者术中免疫功能的影响[J].中国医院药学杂志,2015,35(17):1591-1594.
[21]李莎莎,刘爱秀,曹淑梅,等.老年腹腔镜结直肠癌根治术患者采取多模式镇痛的效果观察[J].结直肠肛门外科,2016,22(6):647-650.