术中单次应用帕瑞昔布对老年患者全麻术后认知功能改变的影响

Effect of single dose utilization of parecoxib during operation on postoperative cognition changes in elderly patients

目的观察术中单次使用帕瑞昔布对老年患者全麻术后认知功能状态产生的影响。方法选择65岁以上,ASAⅡ～Ⅲ级,手术时间3～4 h的胃肠道择期手术患者45例,随机分为2组,实行单盲试验。2组均于全麻常规诱导后,术中持续吸入七氟烷(2%～2.5%),静脉输注丙泊酚调整麻醉深度,维持血氧及血压平稳。手术结束0.5 h,2组随机静脉注射帕瑞昔布40 mg(溶于氯化钠注射液2 mL)或氯化钠注射液2 mL,并予托烷司琼预防术后恶心、呕吐的发生。术前,术后d 2、5、7由同一观察者采用简易智力状态检查法(MMSE)评估患者认知功能状态,并记录术后各项生命体征的变化和不良反应。结果对照组23例,帕瑞昔布组22例,术前各项生命指标及认知状态无显著差异(P>0.05),术中和术后除帕瑞昔布外,各种用药亦无差异。对照组术后d 2、5、7出现认知障碍的患者分别为6、3、1例,帕瑞昔布组为6、3、1例,各时间点差异均无显著意义(P>0.05)。2组术后生命体征和不良反应的发生率组间亦无显著差异(P>0.05)。结论术中单次应用帕瑞昔布对老年患者全麻术后认知功能状态无明显影响。

AIM To observe the effect of single dose utilization of parecoxib during operation on postoperative cognition changes in elderly patients. METHODS Forty-five patients undergoing elective gastrointestinal surgery, age over 65, ASA grade II- III, operative time about 3 - 4 hours were randomly divided into 2 groups, and single-blind observation was performed. After general anesthesia, sevoflurane （controlled at 2% - 2.5%） and continuous intravenous propofol were applied for maintaining blood pressure and blood oxygen saturation. Half an hour before the end of surgery, parecoxib 40 mg （dissolved in 2 mL sodium chloride injection） or 2 mL sodium chloride injection was injected, and tropisetron 5 mg was applied to prevent the occurrence of postoperative nausea and vomiting. All patients＇cognitive function were assessed before operation, and 2 days, 5 days, 7 days after operation repectively by the same observer using mini-mental state examination （MMSE）. The patients＇vital signs, and the occurrence of headache, lethargy, nausea, vomiting were recorded. RESULTS No difference occurred in vital signs and cognitive status between the control group （n = 23） and parecoxib group （rt = 22） before operation, and medicine administration was similar except parecoxib during and after operation （P 〉 0.05）. MMSE scores showed no difference between the two groups in the occurrence of cognitive disorder （P 〉 0.05） ： 6 patients on 2nd day, 3 patients on 5th day and 1 patient on 7th day in the control group; 6 patients on 2nd day, 3 patients on 5th day, 1 patient on 7th day in the parecoxib group. There was no difference between the groups in postoperative vital signs and the occurrence of adverse reactions （P 〉 0.05）. CONCLUSION Single intraoperative application of parecoxib has not significant effect on postoperative cognitive function to elderly patients undergoing general anesthesia.