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目的观察帕瑞昔布钠对行胃癌根治术老年患者颈内静脉炎症反应的影响。方法择期行胃癌根治术的患者30例,年龄60～75岁,体重>50 kg,性别不限,ASAⅠ～Ⅱ级。随机将患者分为三组(n=10):对照组(C)、40 mg帕瑞昔布钠组(P1)和60 mg帕瑞昔布钠组(P2),各组分别于手术前30 min静脉给予生理盐水4 ml、帕瑞昔布钠40 mg(稀释至4 ml),P2组在第一次给药90 min后静注帕瑞昔布钠20 mg(稀释至2 ml)。留取麻醉前(基础值,T0),首次给药后2 h(T1),首次给药后6 h(T2),术后24 h(T3)右颈静脉血样。采用双抗体夹心酶联免疫吸附法测定血清中IL-1β、IL-6、TNF-α及β淀粉样蛋白(Aβ)的浓度。结果与C组相比,P1组及P2组血浆中IL-6、TNF-α及Aβ的浓度在T2～3显著降低,差有统计学意义(P<0.05),血浆IL-1β浓度在P1组仅T3时点及P2组T2～3显著降低,差异有统计学意义(P<0.05);与T0相比,各组血浆中IL-1β、IL-6、TNF-α及Aβ的浓度在T2～3明显升高,差异有统计学意义(P<0.05),IL-1β浓度在P2组仅T2～3时点除外。结论术前静注帕瑞昔布钠可抑制老年胃癌手术患者围术期颈内静脉炎性反应,而术中增加帕瑞昔布钠的用量其抗炎作用并不明显。
Objective To observe the effect of parecoxib sodium on the inflammatory reaction of jugular vein in elderly patients undergoing radical gastrectomy for gastric cancer. Methods Thirty patients undergoing radical gastrectomy were aged 60-75 years old, weighing> 50 kg. Their sex was not limited, ASA Ⅰ ~ Ⅱ grade. Patients were randomly divided into three groups (n = 10): control group (C), 40 mg parecoxib sodium group (P P) and 60 mg parecoxib sodium group (P2) 4 ml of intravenous saline, 40 mg of parecoxib (diluted to 4 ml), and 20 mg of parecoxib sodium (diluted to 2 ml) intravenously in group P2 after 90 min of the first dose. Before anesthesia (baseline, T0), 2 h after the first administration (T1), 6 h after the first administration (T2), and 24 h after the operation (T3), right jugular venous blood samples were collected. Serum levels of IL-1β, IL-6, TNF-α and β-amyloid protein (Aβ) were measured by double antibody sandwich enzyme-linked immunosorbent assay. Results The plasma levels of IL-6, TNF-α and Aβ in group P1 and group P2 were significantly lower than those in group C at T2 ~ 3 (P <0.05), and the plasma concentration of IL-1β was significantly lower at P1 Compared with T0, the plasma levels of IL-1β, IL-6, TNF-α and Aβ in each group were significantly lower than those in T2 group (P <0.05) T2 ~ 3 significantly increased, the difference was statistically significant (P <0.05), IL-1β concentration in the P2 group only T2 ~ 3 o’clock. Conclusions Preoperative intravenous injection of parecoxib can inhibit the perioperative inflammatory response of the jugular vein in elderly patients with gastric cancer. However, the anti-inflammatory effect of parecoxib is not obvious during the operation.