中文摘要：

目的 探讨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.方法 选择限期行肝切除术的80例肝癌患者,随机分帕瑞昔布钠联合芬太尼组（P组,40例）和芬太尼组（C组,40例）.麻醉诱导前（T0）、术毕（T1）、术后24 h、72 h（T2、T3）检测T细胞亚群（CD3＋、CD4＋、CD8＋、CD4 ＋/CD8＋）、NK、IL-4、IFN-γ及IFN-γ/IL-4,视觉模拟评分法（VAS）评价术后镇痛效果、记录术后芬太尼消耗量及不良反应情况.结果 T2时P组CD3＋下降幅度较C组低（t=2.155,P＜0.05）;T2时P组NK恢复至T0水平且高于C组（t=2.791,P＜0.05）,T3时C组CD3＋、NK仍未恢复至T0水平（分别=3.065,3.231,P＜0.05）.T2时P组IL-4水平低于C组,IFN-γ水平高于C组（分别t=2.173,2.100,P＜0.05）,P组IFN-γ/IL-4在T2、T3高于C组（分别t=3.259,2.203,P＜0.05）.P组静息及咳嗽状态下术后2、6、12、24 h VAS评分低于C组（静息分别t=8.661,9.726,9.147,7.109,P＜0.05;咳嗽分别t=8.569,9.614,9.144,8.509,P＜0.05）,芬太尼用量少于C组（t=2.636,P＜0.05）不良反应发生率差异无统计学意义.结论 联合应用帕瑞昔布钠的多模式镇痛可增强肝癌术后镇痛效果,减少阿片类用量,改善肝癌术后患者免疫功能.

英文摘要：

Objective To investigate the effects of multimodal analgesia of parecoxib and fentanyl on perioperative immune functions in patients of hepatocellular carcinoma （HCC）.Methods Eighty HCC patients scheduled for hepatectomy were randomly divided into two groups：parecoxib sodium combined with fentanyl group （group P,40 cases） and fentanyl group （group C,40 cases）.The percentages of CD3 ＋,CD4＋,CD8＋,CD4＋/CD8＋ T cells,CD3-CD16＋ CD56＋ （NK）,interleukin-4 （IL-4）,interferon-γ （IFN-γ） and the ratio of IFN-γ/IL-4 were detected at the following time points：30 minutes before induction of anesthesia （T0）,at the end of the surgery （T1）,24 h after surgery （T2） and 72 h after surgery （T3）.The analgesic effects were estimated by visual analogue scale （VAS） after surgery.Total fentanyl consumption and adverse effects were also recorded.Results The percentages of CD3 ＋ T cells were significantly lower in group C than that in group P at T2 （t =2.155,P 〈0.05）.The percentages of NK in group P were recovered nearly to baseline （T0） at T2,which was higher than that of group C （t =2.791,P 〈0.05）.In group C,the percentages of CD3 ＋ T cells and NK has not recovered to baseline at T3 （respectively t =3.065,3.231,P 〈 0.05）.In group P,IL-4 serum levels were significantly lower than those in group C,while IFN-γ serum levels were significantly higher than those in group C at T2 （respectively t =2.173,2.100,P 〈0.05）.From T2 to T3,the ratio of IFN-γ/IL-4 significantly increased in group P than those in group C （respectively t =3.259,2.203,P 〈 0.05）.VAS scores at rest and on cough in group P were significantly lower than those in group C at 2 h,6 h,12 h and 24 h after operation （respectively t =8.661,9.726,9.147,7.109,P〈0.05;t =8.569,9.614,9.144,8.509,P〈0.05）.The total fentanyl consumption in group P was lower than that in group C （t =2.636,P 〈 0.05）.There were no significant differences regarding the incidence of adverse effects bet