帕瑞昔布钠对老年股骨转子间骨折患者术后疼痛和认知功能的影响

Effect of parecoxib sodium on postoperative pain and cognitive function in elderly patients with intertrochanteric fracture of femur

目的观察帕瑞昔布钠对老年股骨转子间骨折患者术后疼痛和认知功能的影响。方法将64例手术治疗的老年股骨转子间骨折患者采用双盲随机数字表法分为观察组(32例,麻醉前予40 mg帕瑞昔布钠静滴)和对照组(32例,麻醉前予生理盐水静滴),比较两组术后2、6、12、24 h疼痛程度、炎症反应、应激反应及术后认知功能障碍(POCD)发生率。结果观察组术后2、6、12 h疼痛VAS评分均低于对照组,疼痛峰值VAS评分低于对照组,术后6、12、24 h自控镇痛次数均少于对照组,差异均有统计学意义(P <0. 05)。术后3d MMSE评分观察组为(27. 42±2. 17)分,对照组为(25. 04±1. 83)分,差异有统计学意义(P <0. 05)。观察组术后12 h皮质醇、C-反应蛋白水平均低于对照组(P <0. 05)。术后POCD发生率观察组为6. 25%,对照组为31. 25%,差异有统计学意义(P <0. 01)。结论帕瑞昔布钠可减轻老年股骨转子间骨折患者术后疼痛、炎症和应激反应,显著降低术后POCD发生率。

Objective To observe the effect of the parecoxib sodium on postoperative pain and cognitive function in the elderly patients with intertrochanteric fracture of femur. Methods The 64 patients with femoral intertrochanteric were selected as the research object, adopted the double blind random number table method,were divided into the observation group (32 cases,before anesthesia to give 40 mg parecoxib sodium static drops) and the control group (32 cases,before anesthesia to give saline static drops). The postoperative 2,6,12,24 h pain degree, inflammation, stress reaction and the incidence rate of postoperative cognitive dysfunction (POCD) were compared between them. Results The VAS of the observation group at 2,6,12 h postoperatively were lower than those of the control group, the peak value of pain was lower than that of the control group, and the number of self-controlled analgesia at 6,12,24 h postoperatively were lower than those of the control group, and the differences were statistically significant( P< 0.05). MMSE score was (27.42 ±2.17) points in the observation group and (25.04 ±1.83) points in the contro group on 3 d after surgery,there was statistically significant ( P< 0.05). The levels of cortisol and C-reactive protein at 12 h after operation in the observation group were lower than those in the control group ( P< 0.05). POCD incidence rate was 6.25% in the observation group and 31.25% in the control group, and the difference was statistically significant( P< 0.01). Conclusions Parecoxib sodium can alleviate postoperative pain, inflammation and stress response in elderly patients with femoral intertrochanteric fracture, and significantly reduce the incidence of POCD after surgery.