帕瑞昔布钠联合瑞芬太尼对老年骨科术后患者认知功能、氧化应激和术后炎性反应的影响

Effect of parecoxib sodium combined with remifentanil on cognitive function,oxidative stress and postoperative inflammatory reaction in elderly patients after orthopaedic surgery

目的观察帕瑞昔布钠联合瑞芬太尼对老年骨科术后患者认知功能、氧化应激和术后炎性反应的影响。方法回顾性选取2020年3月—2021年1月于茂名市中医院行骨科手术的患者80例,麻醉诱导依次采用咪达唑仑、丙泊酚、瑞芬太尼、罗库溴铵,持续靶控输注丙泊酚、泵注瑞芬太尼,并间断静注维库溴铵维持麻醉。观察组(40例)术前30 min给予帕瑞昔布钠40 mg静脉注射,对照组(40例)麻醉诱导前30 min给予等量生理盐水静脉注射。比较2组患者术前与术后24 h简易精神状态量表(MMSE)评分、血清丙二醛(MDA)和超氧化物歧化酶(SOD)水平及炎性反应指标[肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)]。结果术后24 h,观察组MMSE评分高于对照组(P<0.01);2组患者氧化应激指标出现波动,观察组MDA水平低于对照组(P<0.01),SOD水平高于对照组(P<0.05);观察组TNF-α、IL-6水平低于对照组(P均<0.01)。结论帕瑞昔布钠联合瑞芬太尼可有效改善老年骨科手术患者的认知功能和氧化应激指标,降低患者的炎性反应。

Objective To observe the effect of parecoxib sodium combined with remifentanil on cognitive function,oxidative stress and postoperative inflammatory reaction in elderly patients after orthopaedic surgery.Methods Eighty patients who underwent orthopedic surgery in Maoming Hospital of Traditional Chinese Medicine from March 2020 to January 2021 were selected retrospectively.Midazolam,propofol,remifentanil,rocuronium were used in turn for anesthesia induction.Continuous target controlled infusion of propofol,pump injection of remifentanil,and intermittent intravenous injection of vecuronium bromide were used to maintain anesthesia.The observation group(40 cases)were given 40 mg of parecxib sodium intravenously at 30 minutes before operation,and the control group(40 cases)were given the same amount of normal saline intravenously at 30 minutes before anesthesia induction.To observed preoperative and 24 hours of mini-mental state examination(MMSE)score,the levels of serum malondialdehyde(MDA),superoxide dismutase(SOD),tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6).Results The MMSE score in the observation group was higher than in the control group 24 hours after operation(P<0.01);The oxidative stress indexes of patients in the two groups fluctuated.The MDA level in the observation group was lower than that in the control group(P<0.01),and the SOD level was higher than that in the control group(P<0.05);The levels of TNF-α,IL-6 in the observation group were lower than those in control group(all P<0.01).Conclusion Parexib sodium combined with remifentanil can effectively improve the cognitive function and oxidative stress indexes of elderly patients undergoing orthopaedic surgery,and reduce the inflammatory reaction of patients.