氟比洛芬酯对大肠癌患者术后血清IL-2、IL-6的影响

为探讨氟比洛芬酯静脉注射对大肠癌患者术后血清白介素-2（IL-2）、白介素-6（IL-6）的影响，将120例ASAⅠ-Ⅱ级拟行直肠癌根治术的患者随机分为3组，氟比洛芬酯组（F组）、吗啡组（M组）和曲马多组（T组）各40例。3组均以咪达唑仑0．06mg／kg、芬太尼5μg／kg、丙泊酚1.0mg／kg、罗库溴铵1．5mg／kg麻醉诱导后行气管插管，以七氟烷吸入维持麻醉深度（MAC值2．1左右），术中间断静脉注射顺苯磺酸阿曲库铵维持肌松。于麻醉诱导前10minM组静脉注射吗啡0．1mg／kg，T组静脉注射曲马多1．5mg／kg，F组静脉注射氟比洛芬酯1．5mg／kg。3组分别于术前（T0）、手术结束后3h（T1）、术后1d（T2）和术后3d（T3）取外周静脉血以酶联免疫吸附试验（ELISA）测定血清中IL-2、IL-6的浓度。记录患者术后不良反应，包括恶心、呕吐、皮肤瘙痒等。结果显示，M组IL-2水平在术后3h开始下降（P〈0．05），术后1d时下降到更低的水平（P〈0．01），术后3d时略有回升，但仍然低于麻醉前的水平（P〈0．05）；T组IL-2水平在术后3h与麻醉前比较无差异，术后1d后逐渐升高（P〈0．05），在术后3d恢复到术前水平（P〉0．05）；F组IL-2水平术后3h明显升高，持续至术后1d，与麻醉前比较差异有显著性（P〈0．01），术后3d后略有下降，但仍高于术前水平（P〈0．05）。3组IL-6血清浓度术后3h全部升高，术后1d达顶峰。T组与F组术后1d血清IL-6浓度与M组相比有统计学差异（P〈0．05），而F组升高的幅度较T组小（P〈0．01）。术后3d F组与M组血清IL-6浓度相比，仍有显著性差异（P〈0．05）。M组不良反应的发生率显著高于其他两组（P〈0．05）。F组恶心、呕吐的发生率与M组相比有显著性差异（P〈0．05）。结果表明，与吗啡和曲马多相比，氟比洛芬酯可更好地促进IL-2的分泌，抑制IL-6的升高，且术后不良反应发生率更低，围手术期镇痛更为安全有效。

Influence of Flurbiprofen Axetil on Serum Levels of IL-2,IL-6 in Postoperative Colorectal Cancer Patient

This paper was to discuss the influence of flurbiprofen axetil on serum levels of IL-2, IL-6 in postoperative colorectal cancer patient,120 patients （ASA I-II ） who were about to receive radical resection of rectal cancer were randomly divided into three groups, flurbiprofen axetil group （group F）, morphine group （group M） and tramadol group （group T）, 40 patients for each group. All the three groups were intervened with midazolam 0.06mg/kg, fentanyl 5μg/kg, propofol 1.0mg/kg, rocuronium bromide 1.5 mg/kg for the induction of anesthesia and underwent endotracheal intubation afterwards. Sevoflurane inhalation to maintain the depth of anesthesia （MAC. about 2.1） ,and intermittent intravenous injection of cisatracurium besylate was given to maintain muscle relaxation during the operation. Ten minutes before the induction of anesthesia, group M received intravenous injection of morphine 0. 1l mg/kg,groupT tramadl 1. 5mg/kg and group F flurbiprofen 1.5mg/kg. Periphoral venous blood was collected in 3 groups for detecting serum levels of IL-2 and IL-6 with enzyme-link immunosorbent assay（ELISA） before surgery （T0）, three hours after surgery （T1）,one day after surgery （T2） and 3 days after surgery （T3）. Postoperative ad- verse reactions,including nausea, vomiting,itchy skin etc, were recorded. The results showed that IL-2 levels in group M began to decline 3h after surgery （ P 〈0.05） ,and even to a lower level on T2（ P 〈0.01）, and rebounded slightly on T3 ,but still below the level before anesthesia （ P 〈0.05）;IL-2 levels in T group showed no difference in 3h after surgery and before anesthesia,and increased gradually on T2 （ P 〈0.05）, returned to preoperative levels on T3 （ P〉 0.05） ; IL-2 levels in group F increased significantly 3h after surgery,continuing until T2 ,which were significantly different from those before anesthesia （ P〈0.01）, IL-2 levels had a slight decrease on 3d after surgery,but still higher than the preoperative levels （ P 〈0. 05） . IL-6 serum levels increased 3h after surgery in all three groups and reached to the peak on T2. Serum levels of IL-6 in group T and group F were significantly different from those in group M （ P 〈0.05） .and amplitude of serum levels of IL-6 increased lower in group F than in group T （ P %0.01）. On Ta ,still sig- nificant difference was found between group F and group M（ P 〈0.05） ,and the incidence of adverse reaction in group M was significantly higher than other two groups. There was significant difference between group M and group F in the incidence of nausea and vomiting （ P 〈0.05）. It is concluded that compared with morphine and tramadol, flurbiprofen axetil can better promote the secretion of IL-2, inhibit the increase of IL-6, with more less postoperative adverse reactions, therefore it is more safe and effective for perioperative analgesia.