氯诺昔康超前镇痛对乳腺癌改良根治术后疼痛及血小板CD62p的影响.docVIP

　　氯诺昔康超前镇痛对乳腺癌改良根治术后疼痛及血小板CD62p的影响 作者：王春玲　张丽　李建军　马榕 【摘要】 目的：通过观察氯诺昔康超前镇痛对乳腺癌改良根治术后疼痛的影响以及氯诺昔康对血小板CD62p表达的影响，判定氯诺昔康超前镇痛的有效性和围手术期应用的安全性。方法：将择期行乳腺癌改良根治术的 60例患者随机分为超前镇痛组(Ⅰ组,n=30)和对照组(Ⅱ组,n=30)，均在气管插管全身麻醉下手术。Ⅰ组患者术前30 min给予氯诺昔康16 mg，Ⅱ组患者给予生理盐水4 mL。两组患者均在术前30 min和术后6 h和24 h 3个时相点抽取静脉血2 mL，测定血小板CD62p的表达；观察术后2、6和24 h时静息疼痛视觉模拟（visual analogue scale，VAS）评分，记录术中出血量及术后24、48和72 h引流液的量，记录两组患者术后3 d恶心、呕吐的发生及术后镇痛药物应用情况。结果：两组患者VAS评分在术后2、6和24 h 3个时相点均有差异，Ⅰ组患者疼痛明显减轻（Plt;0.05）；每组患者3个时点血小板CD62p的表达有差异，术后CD62p的表达明显高于术前（Plt;0.05）；两组间术后24 h镇痛药物的需求有差异；两组间术中出血量、术后引流液的量无差异；两组患者恶心、呕吐发生率无差异，未发现其他相关不良反应。结论：氯诺昔康超前镇痛能明显减轻患者术后疼痛，氯诺昔康单剂16 mg应用并未明显影响血小板活化聚集功能，可安全应用于围手术期。 【关键词】 氯诺昔康·超前镇痛·疼痛视觉模拟评分·血小板活化 【ABSTRACT】 Objective: To determine has a preemptive analgesic effect to the patients odified radical mastectomy . To study the effect of lonoxicam on platelet function and investigate the surface expression of p-selectin on platelet by a floetric assay. Methods: After obtaining a ed consent from patients,sixty ASAⅠ－Ⅱpatients，aged 40-60 yr,odified radical mastectomy ly divided into tinistered 16mgof lornoxicam iv.30 minutes prior to surgery, Group II inistered 4 mL placebo. TL blood a peripheral vEIn to analyze the surface expression of p-selectin on platelet,blood sample e points:30 minutes prior to surgery,6h and 24h after surgery.Introoperative blood loss and the volume of drainage fluid 24h,48h,and 72h after surgery ented;PONV and other side effects onstrated reduced pain scores pared to Group II at three specific time points;Great difference for the expression of p-selectin on platelet at certain time point in each group e of drainage fluid betends more analgesics than GroupⅠ.The rate of PONV ilar bet administered preemptively appears to reduce pain scores after surgery,prove the quality of postoperative analgesia.Lornoxicam has no significant effect on platelet activation and aggregation may be safely used in perioperative period. 【KEY eta分析并未证实这些镇痛药物超前镇痛的有效性。2001年之后的的一些研究显示非甾体抗炎镇痛药（nonst