围术期口服环氧化酶-2抑制剂对脑脊液前列腺素水平与术后镇痛效果影响.docVIP

围术期口服环氧化酶-2抑制剂对脑脊液前列腺素水平和术后镇痛效果的影响 山东省聊城市人民医院麻醉科（252000）张宗旺 贾新权 [摘要] 目的 通过围术期口服选择性环氧化酶（COX）-2抑制剂，观察妇科手术后病人脑脊液中前列腺素浓度的变化和对术后镇痛效果的影响。方法：60例择期行妇科手术的患者，ASAⅠ～Ⅱ，年龄45～67岁，随机分为3组，每组20例。尼美舒利组从麻醉前1h至术后48h内口服选择性COX-2抑制剂尼美舒利100mg，每隔12h一次；布洛芬组从麻醉前1h至术后48h内口服非选择性COX抑制剂布洛芬400mg，每隔6h一次；对照组不服用任何药物。分别于麻醉前、术后24h和48h采取脑脊液2ml和静脉血6ml测定脑脊液中6-酮前列腺素F1α、血清中血栓素（TX）B2和前列腺素（PG）E2的浓度。术后采用静脉PCA吗啡进行术后止痛，记录术后2h、6h、12h、24h、48h的视觉模拟评分（VAS）和术后48h累计吗啡需要量。结果：布洛芬可明显抑制血清TXB2生成（P0.05）；尼美舒利可明显抑制脂多糖（LPS）诱导的PGE2的生成（P0.05）；对照组血清TXB2水平和LPS诱导PGE2的生成没有变化。术后48h尼美舒利组脑脊液中6-酮前列腺素F1α水平与术前对比无差异，但明显低于对照组和布洛芬组（P0.05）。术后6h、12h和24h，尼美舒利组病人VAS评分和术后48h累计吗啡总需要量都明显低于对照组和布洛芬组（P0.05）。结论：妇科手术创伤可以诱导脊髓表达COX-2，从而增加PGs的合成参与术后疼痛的形成，围术期口服选择性COX-2抑制剂比其他NSAIDs的镇痛效果更好。 [关键词] 前列腺素，环氧化酶，术后止痛 The effect of perioperative oral selective cyclooxygenase-2 inhibitor on prostaglandin concentration in cerebral spinal fluid and postoperative analgesia following gynecological surgery Zhang Zong-wang*, Jia Xin-quan, Chen Yi-qi, Gregory Meredith. *Department of Anaesthesiology, Liaocheng People’s Hospital, Shandong Province, Liaocheng 252000,China [Abstract] objective: To observe the effect of perioperative oral selective cyclooxygenase-2 inhibitor on prostaglandin concentration in cerebral spinal fluid(CSF) and postoperative analgesia following gynecological surgery. Methods: Sixty ASAⅠ～Ⅱpatients aged 45～67 yr undergoing gynecological surgery were randomly divided into three groups, each of which included 20 cases: the first group received the selective COX-2 inhibitor nimesulide 100mg orally twice daily from 1h before anaesthesia to 48h postoperatively; the second group received the nonselective COX inhibitor ibuprofen 400mg orally four times daily from 1h before anaesthesia to 48h postoperatively; the third group did not receive any medicine during that period. CSF 2ml and venous blood 6ml were collected respectively before anaesthesia, on the first postoperative day and the second postoperative day. CSF was analyzed for 6-keto-PGF1 and venous bloo