帕瑞昔布钠预给药+SGB复合全身麻醉对老年骨科患者术后早期认知功能及炎症因子水平的影响

Effect of parecoxib pretreatment+stellate ganglion block combined with general anesthesia on early postoperative cognitive dysfunction and inflammatory factors in the elderly orthopedic operation patient

目的评价帕瑞昔布钠预给药+星状神经节阻滞(stellate ganglion block,SGB)复合全身麻醉对老年骨科患者术后早期认知功能和炎症因子水平的影响。方法择期行关节置换术患者100例,年龄65~76岁,性别不限,体质量指数(body mass index,BMI)14.8~24.0kg/m2,美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级Ⅱ级,采用随机数字表法分为两组,即对照组(n=50)和观察组(n=50),对照组麻醉诱导前30min静脉注射帕瑞昔布钠40mg,观察组诱导前30min静脉注射帕瑞昔布钠40mg和诱导前15min超声引导下给予右侧SGB。分别于给药前(T_(0))、气管插管后即刻(T_(1))、切皮即刻(T_(2))、切皮后1h(T_(3))、术后4h(T_(4))和术后24h(T_(5))时点抽取颈内静脉血样,采用ELISA法检测血清白细胞介素-6(interleukin-6,IL-6)IL-6、肿瘤坏死因子-α(tumor necrosis factorα,TNF-α)水平。采用蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)评分表评估认知功能,统计术后7d患者术后认知功能障碍(postoperative cognitive dysfunction,POCD)的发生率。结果与对照组比较,观察组T_(1~5)时点血清IL-6、TNF-α浓度降低(P<0.05),MoCA评分均高于对照组(P<0.05),POCD发生率下降(P<0.05)。结论帕瑞昔布钠预给药+SGB复合全身麻醉在老年骨科患者的应用,提高了该类患者术后认知功能评分,降低早期POCD的发生率,值得在临床上推荐使用。

Objective To observe parecoxib pretreatment+stellate ganglion block(SGB)combined with general anesthesia on early postoperative cognitive dysfunction and inflammatory factors in the elderly orthopedic operation patient.Mehtods Totally 100 elderly patients of both sexes,aged 65-76 yr,with body mass index of 14.8-24.0kg/m2,of ASAⅡ,undergoing hip replacement operation,were randomly divided into two groups:control group,experimental group,50 cases in each group.Control group was injected with parecoxib 40mg in 30min before anesthesia induction,while the equal volume of parecoxib was given and SGB on the right side was performed on 15min before induction at experimental group.Venous blood samples were collected before giving parecoxib(T_(0)),intubation immediately(T_(1)),at 0 and 1h after skin incision(T_(2-3)),at 4 and 24h after surgery(T_(4-5))for determination of serum concentrations of interleukin-6(IL-6),tumor necrosis factorα(TNF-α)by ELISA.The cognitive function score was counded with Montreal cognitive assessent(MoCA)and the development of postoperative cognitive dysfunction(POCD)was recorded with in 7 days after surgery.Results Compared with group C,the levels of IL-6,TNF-αand incidences of POCD of experimental group were lower at the T_(1-5) time(P<0.05).Conclusion The application of parecoxib pretreatment+SGB combined with general anesthesia in the elderly orthopedic operation patient.can improve the postoperative cognitive function score of such patients,can decrease the incidence of early postoperative cognitive dysfunction and can be recommended in clinical practice use.