Objective:To observe the effects of preemptive analgesia with parecoxib sodium on differentiation of peripheral T helper cells(Th) in patients with radical mastectomy .Methods :A toal of 50 patients with radical mastectomy were randomly di-vided into parecoxib group(Group P) and the control group(Group C) .Parecoxib sodium(40 mg ,diluted with normal saline into 5 mL ,the same below ) was intravenously injected 1 h before operation in Group P ,and 12 h after the first injection .The same dose of normal saline was intravenously injected in Group C at the same time-point .Patient-controlled intravenous analgesia (PCIA) with fentanyl had implemented in two groups after operation .The levels of interferon-γ(IFN-γ) ,interleukin-4(IL-4) in Th1 and Th2 were measured by flow cytometry before anesthesia(T0) ,2 h(T1) ,12 h(T2) ,24 h(T3) ,48 h(T4)after operation in the two groups .Th1 cell was marked by CD3+ CD8- IFN-γ+ .Th2 cell was marked by CD3+ CD8- IL-4+ .Th1/Th2 was calculated by the level of IFN-γ+ /IL-4+ .The visual analogue scale (VAS) ,Bruggemann comfort scale(BCS) ,dosage of fenta-nyl at each time-point in two groups were compared .Results:VAS scores in group P were significantly lower than those in Group C at T2 ,T3 ,T4 .BCS scores at T1 ,T2 ,T3 in group P were significantly higher than those in Group C .The dosages of fentany at T2 ,T3 in Group P were significantly lower than those in Group C .Compared with T0 ,Th1/Th2 ratios in the two groups at T2 ,T3 ,T4 were lower(P<0 .05) .Th1/Th2 in Group P was higher than those in Group C at T2 ,T3 ,T4(P<0 .05) . Conclusions :Th1/Th2 in patients decreases after radical mastectomy .Preemptive analgesia with parecoxib sodium assisted with fentanyl PCIA can inhibit the shift of the balance of Th1/Th2 towards Th2 type .%目的：观察帕瑞昔布钠超前镇痛对乳腺癌根治术患者外周血辅助性 T细胞（T helper cells ，T h ）分化的影响。方法：将50例行乳腺癌根治术的患者随机分为帕瑞昔布钠组（P组）和对照组（C组），P组于术前1 h静脉注射帕瑞昔布钠40 mg （用0．9％氯化钠液稀释至5 mL ，下同），术后距首次给药12 h再次静脉注射帕瑞昔布钠40 mg ；C组于同时间点静脉注射等剂量的0．9％氯化钠液。术后2组用芬太尼行患者自控静脉镇痛（patient-controlled intravenous analgesia ，PCIA ）。采用流式细胞术检测2组患者麻醉前（T0）、术后2 h（T1）、术后12 h（T2）、术后24 h（T3）、术后48 h（T4）外周血中Th1、Th2细胞内γ-干扰素（interferon-γ，IFN-γ）、白介素4（interleukin-4，IL-4）的水平，用CD3＋CD8-IFN-γ＋标识Th1细胞，用CD3＋ CD8-IL-4＋标识Th2细胞，通过计算IFN-γ＋/IL-4＋值来得出 Thl/Th2值。比较2组患者各时间点的视觉模拟评分（visual analogue scale ， VAS）、舒适度（Bruggemann comfort scale ，BCS）、芬太尼用量。结果：P组 T2、T3、T4时间点 VAS评分明显低于C组（P＜0．05）；P组T1、T2、T3时间点舒适度评分明显高于C组（P＜0．05）；P组 T2、T3时间点芬太尼用量明显少于C组（P＜0．05）。与T0比较，2组患者T2、T3、T4时间点Th1/Th2值均明显下降（P＜0．05）；P组T2、T3、T4时间点Th1/Th2值均高于C组（P＜0．05）。结论：乳腺癌根治术后患者Th1/Th2值降低；帕瑞昔布钠超前镇痛辅以芬太尼进行术后PCIA能够抑制T h1/T h2平衡向T h2型偏移。
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