不同剂量帕瑞昔布对老年骨科全麻患者术后认知功能障碍的影响及机制

The effect of different doses of parecoxib on postoperative cognitive dysfunction of the elderly patients underwent orthopedic operation and its mechanism

目的 分析不同剂量帕瑞昔布对老年骨科全麻患者术后认知功能障碍（POCD）的影响及机制。方法 择期全麻手术的老年患178例,美国麻醉师学会（ASA）Ⅰ~Ⅱ级,随机分为对照组（0.9%Na Cl 5 ml注射）46例,帕瑞昔布低剂量组42例,中剂量47例,高剂量43例。结果 手术前,各组神经特异性烯醇化酶（NSE）、髓磷脂碱性蛋白（MBP）、硫化氢（H2S）、S100B、基质金属蛋白酶（MMP）-3、MMP-9和简易智力状态检查（MMSE）评分无显著差异（P〉0.05）。手术后,各组NSE、MBP、H2S、S100B、MMP-3和MMP-9均明显增高（P〈0.05）,MMSE评分明显降低（P〈0.05）。与对照组比,帕瑞昔布各剂量组NSE、MBP、H2S、S100B、MMP-3和MMP-9均明显降低,MMSE评分明显升高（P〈0.05）,且所有指标的变化趋势与剂量呈依赖性关系（P〈0.05）。结论 帕瑞昔布可剂量依赖性地改善老年患者骨科POCD,老年患者骨科POCD表现为神经功能相关指标、MMP-3和MMP-9水平增高,帕瑞昔布可间接降低神经功能相关指标、MMP-3和MMP-9水平,但直接证据仍需进一步试验证明。

Objective To investigate and analyze the effect of different doses of parecoxib on postoperative cognitive dysfunction of the elderly patients underwent orthopedic operation. Methods 178 elderly patients underwent orthopedic operation were randomly divided in-to 4 groups： 46 cases in the control group, 42 eases in parecoxib low dose group, 47 cases in parecoxib middle dose group, 43 eases in pare- coxib high dose group. Results Before surgery, neuron-specific enolase （NSE） , myelin basic protein （ MBP）, H2S, S100B, ：MMP-3, MMP-9 and MMSE score in all groups had no significant differences （P〉0. 05 ）. After surgery, NSE, blBP, H2 S, S IOOB, MMP-3 and MMP- 9 in all groups had increased （P〈0.05）, MMSE score had decreased （P〈O. 05 ）. Compared with the control group, NSE, MBP, H2S, SIOOB, MMP-3 and MMP-9 had decreased（ P〈0.05 ）. MMSE score had signifieantly increased（ P〈0.05 ）. And all the indicators changed in a way of dose-dependent manner. Conclusions Parecoxib earl improve postoperative cognitive dysfunction of elderly patient undergo orthopedic operation. Neurological function related indieators, MMP-3 and MMP-9 have increased after orthopedic operation. Parecoxib can indi- rectly d.ecrease neurological function related indicators, MMP-3 and MMP-9, but directly decrease function needs further evidenee.