帕瑞昔布钠超前镇痛对老年髋部骨折术后疼痛和应激反应影响

Prospective study on the effect of parecoxib sodium analgesia on pain and stress response after surgery in elderly patients with hip fracture

目的:探讨帕瑞昔布钠超前镇痛对老年髋部骨折术后疼痛、应激反应的影响。方法:分析2017年10月至2019年10月收治的70例老年髋部骨折患者临床资料。根据镇痛模式不同随机分为试验组和对照组,其中试验组35例,年龄65~86(78.5±9.1)岁;男21例,女14例;股骨颈骨折18例,股骨转子间骨折17例。对照组35例,年龄66~88(80.6±8.1)岁;男18例,女17例;股骨颈骨折20例,股骨转子间骨折15例。观察两组术后4、12、24、48、72h的视觉模拟评分(visual analogue scale,VAS),术后7 d谵妄发生率以及应激反应指标:丙二醛(malordialdehyde,MDA),超氧化酶歧化酶(superoxid disrutuse,SOD),皮质醇(cortisol,COR),肾上腺素(epinephrise,E)的含量。结果:VAS评分术后4、12、24、48 h试验组低于对照组,差异有统计学意义(P<0.05),术后72 h时两组无统计学差异(P>0.05)。术后72 h内吲哚美辛栓用量(0.1 g/栓)试验组共0.3 g,对照组1.2 g,试验组比对照组要用量少。术后7 d内发生谵妄试验组2例(5.7%),对照组8例(22.8%),试验组谵妄发生率显著小于对照组(χ~2=4.2,P=0.040)。两组患者术后2d血清SOD含量升高,MDA、E、COR含量降低;且试验组血清MDA、E、COR含量低于对照组,SOD含量高于对照组;差异均有统计学意义(P<0.05)。结论:帕瑞昔布钠的超前镇痛应用,可显著减轻老年髋部骨折患者术后的应激反应,增强术后镇痛疗效,降低术后谵妄的发生率,提高患者的康复质量。

Objective:To investigate the effect of parecoxib sodium preemptive analgesia on pain and stress response after surgery in elderly hip fracture patients.Methods:The clinical data of 70 elderly patients with hip fracture treated in our hospital from October 2017 to October 2019 were prospectively analyzed.According to different analgesic patterns,35 cases were randomly divided into experimental group,aged 65 to 86(78.5±9.1)years,21 males and 14 females,including 18 femoral neck fractures and 17 femoral intertrochanteric fractures.There were 35 cases in control group,aged 66 to 88(80.6±8.1)years,18 males,and 17 females,including 20 cases of femoral neck fractures and 15 cases of intertrochanteric fractures.The visual analogue scale(VAS)at 4 h,12 h,24 h,48 h,and 72 h after surgery,the incidence of delirium and stress indicators of malondialdehyde(MDA),superoxide dismutase(SOD),cortisol(COR),and epinephrise(E)postoperatively in the two groups were observed.Results:At 4 h,12 h,24 h,48 h after surgery,the VAS score of experimental group was lower than that of the control group,and the difference was statistically significant(P<0.05).There was no statistical difference between the two groups at 72 h postoperatively(P>0.05).Within 72 h after surgery,the dosage of indomethacin suppository(0.1 g/suppository)in experimental group was 0.3 g,and that in control group was 1.2 g,the dosage of experimental group was less than that of control group.Within 7 days after operation,delirium occurred in 2 cases(5.7%)in experimental group and 8 cases(22.8%)in control group,the incidence of delirium in experimental group was significantly lower than that in the control group(χ2=4.2,P=0.040).Two days after surgery,the serum SOD content of the two groups of patients increased,and the levels of MDA,E,and COR decreased;and the serum MDA,E,and COR levels of experimental group were lower than control group,and the SOD content was higher than control group;the differences were statistically significant(χ2<0.05).Conclusion:The advanced analgesic application of parecoxib sodium can significantly reduce the postoperative stress response of elderly hip fracture patients,enhance the postoperative analgesic effect,reduce the incidence of postoperative delirium,and improve the quality of rehabilitation of patients.