帕瑞昔布对老年结直肠癌根治术患者脑保护的影响

Effect of Peroxib on Brain Protection in Elderly Patients Undergoing Radical Resection of Colorectal Cancer

目的观察帕瑞昔布对老年结直肠癌根治术患者脑保护作用。方法选择某院2016年1月-2018年1月收治的需行手术治疗的72例老年结直肠癌患者入选本研究,根据平分法分为2组,2组均缓慢静注等剂量长托宁、芬太尼、丙泊酚、顺式阿曲库铵、咪达唑仑行麻醉诱导,待患者意识消失、肌肉松弛后行气管内插管。手术切皮时观察组静注帕瑞昔布40mg,对照组静注等剂量生理盐水。术中均给予等剂量丙泊酚、顺式阿曲库铵、瑞芬太尼维持麻醉深度(脑电双频指数于40～60),术后均给予静脉自控镇痛泵。记录两组手术不同时刻平均动脉压(MAP)及心率(HR)变化,并于手术前、手术结束时刻、术后24h、术后48h抽取静脉血采取酶联免疫法测定血清S100β蛋白、NSE水平,并于术前1天、术后2天、术后7天采取简易智能量表(MMSE)测定认知功能,并记录两组不良反应情况。结果观察组切皮时、术毕时刻平均动脉压及心率水平均低于对照组(均P<0.05);2组手术前血清S100β蛋白、NSE水平比较差异无统计学意义(P>0.05);术毕、术后1天、术后2天观察组血清S100β蛋白、NSE水平均低于对照组,且两组术毕、术后1天、术后2天观察组血清S100β蛋白、NSE水平均高于治疗前(均P<0.05);术后1天、术后3天观察组MMSE评分均高于对照组(均P<0.05);2组不良反应情况差异无统计学意义(P>0.05)。结论帕瑞昔布应用于老年结直肠癌根治术患者血流动力学更为稳定,且降低血清S100β蛋白、NSE水平升高幅度,具有脑保护作用,临床应用安全。

Objective To observe the protective effect of peroxib on the brain of elderly patients undergoing radical resection of colorectal cancer. Methods To select 72 cases of elderly patients with colorectal cancer in our hospital from January 2016 to Januany 2018 were require surgical treatment in this study, according to the split method they were divided into two groups, two groups were slowly static note isodose long ning, fentanyl, propofol, cis atracurium, midazolam anesthesia induction, for patients with unconsciousness, muscle relaxation after endotracheal intubation.The observation group was given 40 mg paracoxib and the control group was given normal saline.All patients were given equal doses of propofol, cis-atracurium and remifentanil to maintain the depth of anesthesia（eeg dual-frequency index was 40～60）, and all patients were given intravenous automatic analgesia pumps.Record surgery at various points in the 2 groups mean arterial pressure（MAP） and heart rate（HR）changes, and ended before the operation, operation time, postoperative 12 h and 24 h, 48 h after postoperative extraction of venous blood taken enzyme-linked immunoassay serum according to beta protein and NSE levels, and in preoperative 1 day,2 days after operation, postoperative 7 days to take simple intelligence scale（MMSE）, cognitive function and record adverse reactions in the 2 groups. Results The mean arterial pressure and heart rate of the observation group were lower than those of the control group（all P〈0.05）. There was no significant difference in serum S100 glycoproteins and NSE levels between the two groups before surgery（P〈0.05）. Finish operation, postoperative 1 day, 2 days after serum according to beta protein and NSE level observation group were lower than the control group, and group 2 bi, 1 day after operation, postoperative observation group 2 days according to serum beta protein and NSE levels were higher than before treatment（P〈0.05）; MMSE score of the observation group 1 day after surgery and 3 days after surgery was higher than that of the control group（all P〈0.05）.The adverse reactions in the two groups were not statistically significant（P〈0.05）. Conclusions Paranal yesterday cloth used in elderly patients with colorectal cancer radical hemodynamic more stable, and the lower serum according to beta protein and NSE levels rised, had cerebral protective effect and safe clinical application.