右美托咪定联合帕瑞昔布钠在全膝关节置换术后多模式镇痛中的应用效果及对患者认知功能的影响

Effects of dexmedetomidine combined with parecoxib sodium on multimode analgesia after total knee arthroplasty and its effect on patients'cognitive function

目的探讨右美托咪定+帕瑞昔布钠在全膝关节置换术(TKA)多模式镇痛(MA)中的应用效果及对认知功能的影响。方法选择2017年1月至2019年12月在江苏省盱眙县人民医院行TKA的188例患者作为研究对象,术后按随机数表法分为MA组与术后患者自控静脉镇痛(PCIA)组,每组94例。MA组患者麻醉诱导前半个小时给予帕瑞昔布钠、盐酸右美托咪定注射,术后给予PCIA,PCIA组术后仅给予PCIA。在入室时(T0)和术后12 h(T1)、24 h(T2)、48 h(T3)行视觉模拟量表(VAS)评分、镇静Ramsay评分,术前24 h(T01)、T2、术后72 h(T4)行简易精神状态量表(MMSE)评分,测定两组血清S-100β、神经元特异性烯醇化酶(NSE)水平;记录术后48 h内两组不良反应、术后72 h内认知功能障碍(POCD)发生率。结果MA组T1、T2、T3时VAS评分、舒芬太尼用量均显著低于PCIA组,Ramsay评分显著高于PCIA组,差异均有统计学意义(P<0.05);MA组不良反应总发生率、POCD发生率分别为5.32%(5/94)、8.51%(8/94),均显著低于PCIA组的20.21%(19/94)、27.66%(26/94),差异均有统计学意义(P<0.05)。MA组T2、T4时MMSE评分显著高于PCIA组[(26.42±1.68)分比(25.30±1.74)分、(27.06±1.93)分比(26.49±1.87)分],血清S-100β水平显著低于PCIA组[(1.35±0.17)μg/L比(1.43±0.19)μg/L、(1.26±0.13)μg/L比(1.40±0.16)μg/L],NSE水平显著低于PCIA组[(0.88±0.05)μg/L比(0.94±0.06)μg/L、(0.83±0.06)μg/L比(0.91±0.04)μg/L],差异均有统计学意义(P<0.05)。结论右美托咪定+帕瑞昔布钠MA用于TKA术后镇痛效果明确,能明显减少POCD发生,且安全性高。

Objective To investigate the effect of dexmedetomidine combined with parecoxib sodium on multimode analgesia during total knee arthroplasty(TKA)and its effect on cognitive function.Methods One hundred and eighty-eight patients who underwent TKA from January 2017 to December 2019 in People′s Hospital of Xuyi County were divided into the multimode analgesia(MA)group and the postoperative patient-controlled intravenous analgesia(PCIA)group by the method of random number table,each group with 94 patients.Patients in the MA group were injected with parecoxib sodium and dexmedetomidine hydrochloride half an hour before anesthesia induction and PCIA after the operation,while PCIA was only given after the operation in the PCIA group.Visual analogue scale(VAS)and sedation Ramsay scores were performed at the time of entry into the operation room(T0),12 h(T1),24 h(T2)and 48 h(T3)postoperatively;simple mental state scale(MMSE)score,serum S-100β,and neuron-specific enolase(NSE)levels were measured at 24 h before the operation(T01),T2,and 72 h after the operation(T4).The incidence of adverse reactions within 48 h after surgery and postoperatively cognitive dysfunction(POCD)in the two groups within 72 h after surgery were recorded and compared.Results The VAS scores and sufentanil dosage at T1,T2 and T3 in the MA group were significantly lower than those in the PCIA group(P<0.05),and Ramsay scores were significantly higher than those in the PCIA group(P<0.05).The total incidence of adverse reactions and POCD in the MA group were significantly lower than that in the PCIA group:5.32%(5/94)vs.20.21%(19/94),8.51%(8/94)vs.27.66%(26/94),there were significant differences(P<0.05).At T2 and T4,the MMSE scores in the MA group were significantly higher than that in the PCIA group:(26.42±1.68)scores vs.(25.30±1.74)scores,(27.06±1.93)scores vs.(26.49±1.87)scores;the S-100βlevel in the MA group were significantly lower than that in the PCIA group:(1.35±0.17)μg/L vs.(1.43±0.19)μg/L,(1.26±0.13)μg/L vs.(1.40±0.16)μg/L;the NSE level in the MA group were significantly lower than that in the PCIA group:(0.88±0.05)μg/L vs.(0.94±0.06)μg/L,(0.83±0.06)μg/L vs.(0.91±0.04)μg/L,there were significant differences(P<0.05).Conclusions Dexmedetomidine combined with parecoxib sodium multimode analgesia has clear analgesia effect after TKA,can significantly reduce the occurrence of POCD and has high safety.