Abstract: Objective To explore the preemptive analgesic effects of different doses of flurbiprofen axetil during radical resection of cervical cancer and their effects on serum chemokine CXC ligand 13 (CXCL13), interleukin-6 (IL-6), and lung protection effect. Methods A total of 136 patients with cervical cancer admitted to Weihai Central Hospital from February 2018 to August 2020 were selected as the research objects, and were grouped according to the random number table method, with 34 cases in each group. The age of the control group was (44.08±5.02) years old, the age of the observation group 1 was (45.26±4.95) years old, the age of the observation group 2 was (44.89±5.33) years old, and the age of the observation group 3 was (43.25±5.12) years old. All patients underwent laparoscopic radical resection. The control group was given normal saline 30 min before the operation, the observation group 1 was given 0.5 mg/kg of flurbiprofen axetil 30 min before the operation, the observation group 2 was given 1.0 mg/kg of flurbiprofen axetil 30 min before the operation, and the observation group 3 was given 1.5 mg/kg of flurbiprofen axetil 30 min before the operation. The hemodynamic indexes [heart rate (HR) and mean arterial pressure (MAP)] and lung protection effect indexes [dynamic lung compliance (Cdyn) and peak airway pressure (Ppk)] at 4 time points [entering the room (T1), immediately after intubation (T2), immediately after extubation (T3), and 5 min after extubation (T4)], serum CXCL13 and IL-6 levels before and after the operation, analgesic effects 2 h, 4 h, 8 h, 12 h, and 48 h after the operation [Visual Analogue Scale (VAS) score and comfort level score (BCS)], and the incidence of postoperative additional analgesic drugs and incidence of adverse reactions were compared among the 4 groups. One-way ANOVA was used for comparison of the measurement data among multiple groups, LSD-q test was used for further comparison between groups, and χ2 test was used for the count data. Results The fluctuation ranges of HR and MAP of the observation group 3 and the observation group 2 at T3 and T4 were smaller than those of the observation group 1 and the control group (all P<0.05). The Cdyn in the observation group 3 and the observation group 2 at T2, T3 and T4 were higher than those in the observation group 1 and the control group, while the Ppk was lower than that in the control group, with statistically significant differences (all P<0.05). The serum levels of CXCL13 and IL-6 in the observation group 3 and the observation group 2 were lower than those in the observation group 1 and the control group 2 h, 12 h, and 48 h after the operation, with statistically significant differences (all P<0.05). The VAS scores of the observation group 3, observation group 2, observation group 1, and control group decreased successively, and the BCS scores increased successively 2 h, 4 h, 8 h, 12 h, and 48 h after the operation, with statistically significant differences (all P<0.05). The incidence of postoperative additional analgesic drugs in the observation group 3 was 11.76% (4/34), which was lower than 32.35% (11/34) in the observation group 2, 47.06% (16/34) in the observation group 1, and 52.94% (18/34) in the control group, with a statistically significant difference (P<0.05); there was no statistically significant difference in the incidence of postoperative additional analgesic drugs among the observation group 2, the observation group 1, and the control group (P>0.05). Conclusions 1.0 mg/kg or 1.5 mg/kg of flurbiprofen axetil can reduce the hemodynamic fluctuation during radical resection of cervical cancer, has a good lung protection effect, and can reduce the body's inflammatory response; 1.5 mg/kg of flurbiprofen axetil can provide a better postoperative analgesia effect, reduce additional postoperative analgesic drugs, ensure patients' comfort, with good safety.

Key words: Radical resection of cervical cancer, Flurbiprofen axetil, Preemptive analgesia, Chemokine CXC ligand 13, Interleukin-6, Hemodynamics, Lung protection effect

摘要： 目的 探究不同剂量氟比洛芬酯超前镇痛在宫颈癌根治术中的镇痛效果及对血清趋化因子CXC配体13（CXCL13）、白介素-6（IL-6）、肺保护效应的影响。方法 选取2018年2月至2020年8月威海市中心医院收治的136例宫颈癌患者作为研究对象，按照随机数字表法分4组，各34例。对 照组年龄（44.08±5.02）岁，观察1组年龄（45.26±4.95）岁，观察2组年龄（44.89±5.33）岁，观察3组年龄 （43.25±5.12）岁。均行腹腔镜根治术治疗，对照组术前30 min给予生理盐水，观察1组术前30min给予0.5 mg/kg 氟比洛芬酯，观察2 组术前30min给予1.0 mg/kg 氟比洛芬酯，观察3组术前30 min 给予1.5 mg/kg氟比洛芬酯。比较4组入室时（T1 ）、插管即刻（T2 ）、拔管即刻（T3 ）、拔管后5min（T4 ）各时点血流动力学指标［心率（HR）、平均动脉压（MAP）］、肺保护效应指标［肺动态顺应性（Cdyn）、气道峰压 （Ppk）］，手术前后血清 CXCL13、IL-6 水平，术后 2 h、4 h、8 h、12 h、48 h 镇痛效果［视觉模拟评分 （VAS）、舒适度评分（BCS）］，术后追加镇痛药物发生率及不良反应发生率。计量资料多组间比较采用单因素方差分析，进一步两组间比较采用 LSD-q检验，计数资料采用 χ2 检验。结果 观察3组、观察2组 T3～T4时点 HR、MAP 波动幅度小于观察1组、对照组（均 P<0.05）。观察3组、观察2组 T2、T3、 T4时点Cdyn均高于观察1组、对照组，Ppk均低于观察1组、对照组，差异均有统计学意义（均P<0.05）。 观察3组、观察2组术后2h、12h、48h血清CXCL13、IL-6水平均低于观察1组、对照组，差异均有统计学意义（均P<0.05）。术后2h、4h、8h、12h、48h观察3组、观察2组、观察1组、对照组VAS评分依次降低，BCS评分依次升高，差异均有统计学意义（均 P<0.05）。观察3组术后追加镇痛药物发生率 11.76%（4/34），低于观察2组32.35%（11/34）、观察1组47.06%（16/34）、对照组52.94%（18/34），差异有统计学意义（P<0.05）；观察2组、观察1组、对照组术后追加镇痛药物发生率比较，差异无统计学意义 （P>0.05）。结论 1.0 mg/kg或1.5 mg/kg氟比洛芬酯可降低宫颈癌根治术中血流动力学波动，具有良好肺保护效应，能减轻机体炎性反应，且1.5 mg/kg氟比洛芬酯应用时可提供较好的术后镇痛效果，减少术后镇痛药物追加，确保患者舒适度，且安全性良好。

关键词: 宫颈癌根治术, 氟比洛芬酯, 超前镇痛, 趋化因子 CXC 配体 13, 白介素-6, 血流动力学, 肺保护效应