帕瑞昔布钠联合舒芬太尼对老年骨科术后患者认知功能及炎性反应的影响

Effect of parecoxib sodium combined with sufentanil on cognitive function and inflammatory response in elderly patients after orthopedic surgery

目的探讨帕瑞昔布钠联合舒芬太尼对老年骨科术后患者认知功能及炎性反应的影响。方法本研究对象为我院2019年1月~2020年1月收治的100例老年骨科手术患者,采用随机数字表法分为对照组与观察组。对照组50例患者采用舒芬太尼常规麻醉,观察组50例患者在对照组基础上联合帕瑞昔布钠。观察比较两组患者术前、术后3h、24h、3d的血清肿瘤坏死因子-α(TNF-α)、白细胞介素6(IL-6)水平,采用简易智力状态检查量表(MMSE)评估两组患者术前、术后3h、24h、3d的认知功能,并比较认知功能障碍发生率。结果 (1)术后3h、24h、3d时两组患者血清TNF-α、IL-6水平均高于术前,观察组患者术后3h、24h血清TNF-α、IL-6水平均低于对照组(P<0.05),术后3d两组患者血清TNF-α、IL-6水平比较差异无统计学意义(P>0.05)。(2)术后3h、24h、3d时两组患者MMSE评分均低于术前(P<0.05);观察组患者术后3h、24h时MMSE评分高于对照组(P<0.05),术后3d两组患者MMSE评分比较差异无统计学意义(P>0.05)。(3)观察组患者认知功能障碍发生率为8.00%,低于对照组的24.00%(χ2=5.762,P=0.016)。结论帕瑞昔布钠联合舒芬太尼能降低老年骨科术后患者认知功能障碍发生率,并降低术后早期炎性反应程度,值得临床推广应用。

Objective To investigate the effects of parecoxib sodium combined with sufentanil on cognitive function and inflammatory response in elderly patients after orthopedic surgery. Methods A total of 100 elderly patients undergoing orthopedic surgery in our hospital from January 2019 to January 2020 were selected and randomly divided into the control group and the observation group. The control group(50 cases)received routine sufentanil anesthesia,and the observation group(50 cases)received combined with parecoxib sodium on the basis of the control group. Serum levels of tumor necrosis factor-α(TNF-α)and interleukin 6(IL-6)between the two groups before and 3 h,24 h and 3 d after surgery were compared. The cognitive function between the two groups before and 3 h,24 h and 3 d after surgery was evaluated by MMSE,and the incidence of cognitive dysfunction was compared. Results (1)The serum levels of TNF-α and IL-6 in the two groups at 3 h,24 h and 3 d after surgery were significantly higher than those before surgery,and the serum levels of TNF-α and IL-6 in observation group at 3 h and 24 h after surgery were significantly lower than those in control group(P<0.05). There was no significant difference in serum TNF-α and IL-6 levels between the two groups 3 days after surgery(P>0.05).(2)The MMSE scores of the two groups at 3 h,24 h and 3 d after surgery were lower than those before surgery(P<0.05). MMSE scores in observation group were higher than those in control group at 3 h and 24 h after surgery(P<0.05),and there was no significant difference in MMSE scores between the two groups at 3 h after surgery(P>0.05).(3)The incidence of cognitive dysfunction in the observation group was 8.00%,significantly lower than that in the control group(24.00%)(χ2=5.762,P =0.016). Conclusion Parecoxib sodium combined with sufentanil can significantly reduce the incidence of cognitive dysfunction in elderly patients after orthopedic surgery,and reduce the degree of early postoperative inflammatory response,which is worthy of clinical application.