帕瑞昔布钠和氟比洛芬脂对老年患者术后早期认知功能障碍的影响

The Effects of Parecoxib Sodium and Flurbiprofen Axetil on Early Postoperative Cognitive Dysfunction in Elderly Patients

目的:探讨帕瑞昔布纳和氟比洛芬酯对老年患者术后早期认知功能障碍的影响。方法:择期骨科行髋关节置换手术患者60例,ASAⅠ或Ⅱ级,年龄>60岁,体重指数在20~22 kg/m2。按信封法随机分为对照组20例,术前、术毕静注生理盐水2 mL;帕瑞昔布钠组20例,术前静注帕瑞昔布钠40 mg,12 h后静注帕瑞昔布钠40 mg;氟比洛芬脂组20例,术前、术毕静注氟比洛芬脂50 mg。术中使用闭环靶控输注丙泊酚和瑞芬太尼全凭静脉麻醉。观察三组患者手术和麻醉时间、丙泊酚和瑞芬太尼用量,术毕拔管时间和意识恢复时间,口述疼痛评分,拔管期镇静和躁动评分,术后PCA按压次数和PCA用量。检测术前(T0)、术毕(T1)、术后1 d(T2)、术后3 d(T3)和术后7 d(T4)的血清S100β和tau蛋白浓度。于术前1 d、术后7 d对患者进行MMSE评分,比较阳性率。结果:三组患者手术和麻醉时间,丙泊酚和瑞芬太尼用量,拔管时间和意识恢复时间比较差异均无统计学意义(P>0.05)。对照组口述疼痛评分、镇静评分和躁动评分均高于其余两组(P<0.05)。对照组PCA按压次数和PCA用量比帕瑞昔布钠组、氟比洛芬脂组多(P<0.05)。S100β和tau蛋白在T1、T2、T3和T4时间点,三组间比较差异均有统计学意义(P<0.05),表现为对照组>氟比洛芬脂组>帕瑞昔布钠组(P<0.05)。POCD阳性率对照组均高于其余两组(P<0.05),帕瑞昔布钠组和氟比洛芬脂组比较差异无统计学意义(P>0.05)。结论:帕瑞昔布纳或氟比洛芬脂可降低术后血浆S100β和tau蛋白浓度,对老年患者术后早期认知功能障碍有一定的改善作用。

Objective:To investigate the effect of Parecoxib and Flurbiprofen Axetil on postoperative cognitive dysfunction in elderly patients.Method:Sixty ASAⅠorⅡpatients,aged over 60 years,with body mass index of 20-22 kg/m2 were selected for hip replacement surgery in orthopaedics department.According to the envelope method,they were randomly divided into control group of 20 cases,2 mL of normal saline was injected before and after operation.In Parecoxib Sodium group of 20 cases,Parecoxib Sodium 40 mg was injected intravenously before operation,and Parecoxib Sodium 40 mg was injected intravenously 12 hours later.Flurbiprofen Axetil group of 20 cases were injected with Flurbiprofen Axetil 50 mg preoperatively and postoperatively.Closedloop target-controlled infusion of Propofol and Remifentanil was used for total intravenous anesthesia during the operation.The operation and anesthesia time,Propofol and Remifentanil dosage,extubation time and consciousness recovery time after operation,oral pain score,sedation and agitation score during extubation period,PCA pressing times and PCA dosage after operation were observed in the three groups of patients.Serum S100βand tau protein concentrations were measured before surgery(T0),after surgery(T1),postoperative 1 day(T2),postoperative 3 days(T3),and postoperative 7 days(T4).The patients were MMSE scored 1 day before surgery and 7 days after surgery,and the positive rate was compared.Result:There was no significant difference in operation and anesthesia time,Propofol and Remifentanil dosage,extubation time and consciousness recovery time between the three groups(P>0.05).The oral pain score,sedation score and agitation score of the control group were higher than those of the other two groups(P<0.05).The number of PCA compressions and PCA dosage in the control group were higher than those in the Parecoxib Sodium group and Flurbiprofen Axetil group(P<0.05).S100βand tau protein were different among the three groups at time points T1,T2,T3 and T4,which showed as control group>Flurbiprofen Axetil group>Parecoxib Sodium group(P<0.05).The positive rate of POCD in the control group was higher than that in the other two groups(P<0.05),while there was no difference between the Flurbiprofen Axetil group and Parecoxib Sodium group(P>0.05).Conclusion:Parecoxib Sodium or Flurbiprofen Axetil can reduce the concentration of S100βand tau protein in postoperative plasma,and has a certain improvement effect on the early postoperative cognitive dysfunction of elderly patients.