右美托咪定联合帕瑞昔布钠对老年颈椎间盘突出症患者术后应激及认知功能的影响

Effect of dexmedetomidine combined with parecoxib sodium on postoperative stress and cognitive function in elderly patients undergoing cervical disc herniation surgery

目的观察右美托咪定(DEX)联合帕瑞昔布钠(PAX)对老年颈椎间盘突出症患者术后应激及认知功能的影响。方法60例择期行手术治疗的颈椎间盘突出症老年患者,年龄66-83岁,美国麻醉医师学会(ASA)Ⅱ或Ⅲ级,按随机数字表分为3组,每组20例:对照组(C组)、DEX(D组)、DEX+PAX(DP组)。D组在诱导前静脉泵入DEX负荷量0.2μg·kg^(-1),输入时间10 min,接着以0.2μg·kg^(-1)·h^(-1)维持,手术结束前30 min停止。DP组泵入DEX(同D组),分别于手术开始和结束前10min静脉注射帕瑞昔布钠20 mg。C组仅给予等量生理盐水。评估术后1、4、12、24 h视觉模拟(VAS)疼痛评分,24 h内舒芬太尼用量及不良反应情况。于术前1 d(T_0)、术后4h(T_1)、1 d(T_2)、2d(T_3)、3d(T_4)时,评估简易精神状态量表(MMSE)评分,在T_0～T_4时采集静脉血检测血浆葡萄糖(Glu)和C-反应蛋白(CRP)浓度。结果在术后1-12 h各时点,DP组VAS评分明显低于C组和D组(P<0.05);在T_1～T_4时,DP组Glu[(6.6±0.1)、(6.7±0.4)、(5.6±0.5)、(5.4±0.2)mmol·L^(-1)]和CRP[(11.5±3.1)、(28.3±4.2)、(24.8±4.0)、(253.3±5.2)mg·L^(-1)]明显低于C组和D组(P<0.05),DP组MMSE评分[(24.8±0.3)、(26.9±0.8)、(27.6±0.6)、(27.8±0.7)分]明显高于C组和D组(P<0.05)。结论联合应用小剂量DEX和PAX能更有效抑制老年颈椎间盘突出症患者术后炎症和应激,改善术后认知功能。

Objective To evaluate the effect of dexmedetomidine(DEX)combined with parecoxib sodium(PAX)on post-operative stress and cognitive function in elderly patients undergoing cervical disc herniation surgery.Methods Sixty elderly patients,aged 66-83 yr,ASAⅡ-Ⅲ,scheduled for elective cervical disc herniation surgery,were randomly assigned into 3 groups(n=20):control group(group C),DEX group(group D),DEX+PAX group(group DP).In group D,patients were given a load dosage of DEX 0.2μg·kg-1 intravenously within 10 min before anesthesia induction,followed by a continuous infusion of 0.2μg·kg-1·h-1 till 30 min before the end of operation.In group DP,patients were given DEX in accordance with group D,and were given PAX 20 mg at the beginning and the end of surgery,respectively.Patients in group C were given the same volume of isotonic saline.The VAS scores were evaluated at 1,4,12,24 h after surgery,and dosage of sufentanil,incidence of side effects within 24 h were recorded and evaluated.Patients′cognitive functions were evaluated with mini mental state examination(MMSE)at 1 d before and 4 h(T1),1 d(T2),2 d(T3),3 d(T4)after surgery,and the level of blood glucose(Glu),C-reactive protein(CRP)were detected at the same time.Results The VAS scores in group DP were significantly lower than group C and group D at all time points from 1 to 12 hours after surgery(P<0.05);Glu levels were[(6.6±0.1),(6.7±0.4),(5.6±0.5),(5.4±0.2)mmol·L-1,respectively]and CRP levels were[(11.5±3.1),(28.3±4.2),(24.8±4.0),(253.3±5.2)mg·L-1,respectively]in group DP at T1 to T4,which were lower than in group C and group D(P<0.05),MMSE scores were[(24.8±0.3),(26.9±0.8),(27.6±0.6),(27.8±0.7)points,respectively]in group DP at T1 to T4,which was higher than in group C and group D(P<0.05).Conclusions Combined application of DEX and PAX can more effectively inhibit post-operative stress and inflammation,and can improve post-operative cognitive function in elderly patients undergoing cervical disc herniation surgery.