右旋美托咪定复合帕瑞昔布对老年患者术后认知功能的影响

Effect of dexmedetomidine combined with parecoxib on postoperative cognitive function in elderly patients received operation

目的观察右旋美托咪定复合帕瑞昔布对老年患者术后认知功能的影响。方法选取50例60～70岁择期行肺癌根治术的患者，随机平均分为2组：DP组（右旋美托咪定靶控输注＋帕瑞昔布40nlg静脉注射）和DN组（右旋美托咪定靶控输注＋生理盐水5mL静脉注射）。观察记录患者手术结束后自主呼吸恢复时间、轻唤睁眼时间及拔管时间，同时采用简易智力状态检查表（MMSE）评价认知功能，并分别测定患者手术前1d、术后1h和24h的血清S100β蛋白和炎性相关因子IL-6、TNF-α含量。结果2组患者手术后自主呼吸恢复时间、轻唤睁眼时间、拔管时间及术前MMSE评分值比较均无统计学差异（P〉0．05）。DN组术后1、3、5dMMSE评分较DP组低（P〈0．05），且DN组术后1、24hS10％蛋白及炎性因子IL-6、TNF-α测定值均较DP组高（P〈0．05）。结论右旋美托咪定复合帕瑞昔布能有效缓解老年患者胸部手术术后认知功能障碍（POCD），可能与降低炎性细胞的血清水平相关。

To evaluate the effect of dexmedetomidine combined with parecoxib on postoperative cognitive function in elderlypatients received thoracic surgery. Methods Fifty patients underwent radical resection of pulmonary carcinoma were divided into DP group （dexmedetomidine infusion by micro pumo and parecoxib 40 mg through intravenous injection） and DN group （dexmedetomidine infusion by micro pumo and nomal saline 5mL through intravenous injection）. The time for spontaneous breath, eye opening and extubation after the oper- ation were recorded. The mimi-mental state examination （ MMSE ） was used to assess the cognitive function. The concentration of protein S100β and IL-6 ,TNF-α were determined at 1 d before operation and 1 h ,24 h after the operation. Results The difference of time for spon- taneous breath, eye opening, extubation and preoperative values of MMSE between two groups were not statistically significant （ P 〉 0.05 ）. MMSE scores at 1 d,3 d and 5 d after operation in group DN were lower than those in group DP （P 〈0.05）. The values of S100β,IL-6, TNF-α at 1 h and 24 h after operation in group DN were higher than that in group DP （ P 〈 0.05 ）. Conclusion Dexmedetomidine com- bined with parecoxib can decrease the incidence of postoperative cognitive dysfunction in elderly patients underwent thoracic surgery, and the mechanism of which may be related to the downregulation of serum inflammatory factors.