两种非甾体类镇痛药对老年妇瘤腹腔镜手术术后疼痛及认知功能影响的临床研究

Comparison of the analgesic effect of two kinds of non-steroidal analgesics on elderly gynecologic laparoscopic surgery and their impact on cognitive functionn

目的比较氟比洛芬酯和帕瑞昔布钠对老年妇科腹腔镜手术后疼痛及认知功能的影响。方法择期全麻气管插管下行腹腔镜手术的老年女性患者80例,随机分为4组:F1组全麻插管后给予氟比洛芬酯50 mg,F2组术毕前30 min给予氟比洛芬酯50 mg,P1组全麻插管后给予帕瑞昔布钠40 mg,P2组术毕前30 min给予帕瑞昔布钠40 mg,每组20例。所有患者均采用常规麻醉诱导及术中维持,术后连接相同配方的静脉镇痛泵转入麻醉恢复室。记录各时点的HR、MAP,记录术后6 h、12 h及24 h的VAS疼痛评分以及各组拔管后10 min的Ramsay镇静评分和Riker-SAS躁动评分,记录术前,术后24 h、72 h的认知功能障碍情况。结果术后6 h的VAS评分F2和P2组明显低于F1和P1组(P<0.05),P1和P2组的VAS评分在术后12 h低于F1和F2组,4组患者术后24 h的VAS评分差异无统计学意义(P<0.05)。与术前24 h比较,4组患者术后24 h的MMSE评分均下降,差异有统计学意义(P<0.05);与F2和P2组比较,F1和P1组24 h时MMSE评分升高,术后72 h内POCD发生率较低(P<0.05)。结论两种非甾体类镇痛药均可以降低POCD的发生率,在插管后给予帕瑞昔布钠用于术后镇痛更趋于合理。

Objective To compare the analgesic effect of flurbiprofen and parecoxib sodium on gynecological laparoscopic surgery for the elderly and their influence on cognitive function. Methods Elective laparoscopic surgery were preformed under endotracheal intubation general anesthesia in 80 elderly women. The patients were randomly divided into four groups： Group F1 was given flurbiprofen axetil 50 mg after intubation, Group F2 received flurbiprofen axetil 50 mg half an hour before the end of the surgery, and Group P1 was given parecoxib sodium 40 mg after intubation, group P2 received parecoxib sodium 40 mg half an hour before the end of the surgery; 20 patients in each group. All patients with general anesthesia induction and intraoperative, postoperative intravenous analgesia pump connecting the same recipe to anesthesia recovery room. HR, MAP at each time point were recorded, HR and MAP were recorded 6 h, 12 h and 24 h after anesthesia and VAS pain score, Ramsay sedation scores and Riker-SAS agitation score were recorded preoperatively and 24 h, 72 h and postoperatively to measure cognitive dysfunction. Results The VAS score 6 h after operation of F2 and P2 was significantly lower than F1 and P1 group（P〈0.05）, VAS score of the P1 and P2 group 12 h after surgery was lower than F1 and F2 group. Postoperative VAS score of the four groups was not statistically different at 24 h（P〈0.05）.Compared with 24 h preoperative, MMSE score in the four groups of patients 24 h postoperatively was decreased, the difference was statistically significant（P〈0.05）. Compared with F2 and P2 group, 24 h MMSE score of the F1 and P1 group was increased, the incidence of POCD within 72 h was lower（P〈0.05）. Conclusion These two non-steroidal analgesics can reduce the incidence of POCD, giving parecoxib sodium after intubation seems to be more reasonable for postoperative analgesia.