帕瑞昔布钠联合右美托咪定用于骨质疏松压缩骨折患者手术的临床研究

Clinical trial of parecoxib sodium combined with dexmedetomidine for surgery in patients with osteoporotic compression fractures

目的探讨注射用帕瑞昔布钠联合盐酸右美托咪定注射液对骨质疏松压缩骨折患者术后认知功能、应激反应的影响。方法将骨质疏松压缩骨折患者根据治疗方案分为试验组与对照组。对照组静脉注射盐酸右美托咪定注射液0.2μg·kg^(-1)负荷剂量,然后微量泵注射0.2μg·kg^(-1)·min^(-1)维持剂量,至手术结束前30 min;试验组在对照组的基础上于局麻前和手术结束前30 min分别静脉注射注射用帕瑞昔布钠20 mg。比较2组患者术前(T_(0))、术后2 h(T_(1))、术后6 h(T_(2))、术后12 h(T_(3))、术后24 h(T_(4))的疼痛、镇静、血流动力学[平均动脉压(MAP)、心率(HR)]、认知功能,并进行安全性评价。结果试验组入组39例,对照组入组41例。试验组和对照组T_(1)的视觉模拟(VAS)评分分别为(3.09±0.55)和(3.41±0.62)分,T_(2)的VAS评分分别为(3.02±0.57)和(3.35±0.48)分,T_(3)的VAS评分分别为(2.64±0.44)和(2.90±0.46)分,T_(4)的VAS评分分别为(2.02±0.41)和(2.35±0.47)分,T_(2)的简易智力状态量表(MMSE)评分分别为(25.28±1.57)和(24.33±1.42)分,T_(4)的MMSE评分分别为(28.16±1.01)和(27.25±0.89)分,T_(2)的蒙特利尔认知评估量表(MoCA)评分分别为(24.63±1.60)和(23.59±1.25)分,T_(4)的MoCA评分分别为(27.20±0.97)和(26.48±0.83)分,试验组的上述指标与对照组比较,在统计学上差异均有统计学意义(均P<0.05)。试验组的药物不良反应有心动过缓、低血压、恶心呕吐、低钾血症;对照组的药物不良反应有心动过缓、低血压、恶心呕吐。试验组和对照组的总药物不良反应发生率分别为12.82%和9.76%,在统计学上差异无统计学意义(P>0.05)。结论帕瑞昔布钠联合盐酸右美托咪定注射液与单用盐酸右美托咪定注射液相比,有利于缓解骨质疏松压缩骨折患者术后疼痛,改善术后认知功能。

Objective To investigate the effects of parecoxib sodium injection combined with dexmedetomidine hydrochloride injection on postoperative cognitive function and stress response in patients with osteoporotic compression fractures.Methods The patients with osteoporotic compression fractures were divided into treatment group and control group according to the treatment plan.The control group was given intravenous injection of dexmedetomidine hydrochloride injection 0.2μg·kg^(-1)load dose,then micro pump injection 0.2μg·kg^(-1)·min^(-1)maintenance dose,until 30 min before the end of the operation;patients in the treatment group were intravenously injected with parecoxib sodium injection 20 mg before local anesthesia and30 min before the end of operation on the basis of the control group.The pain,sedation,hemodynamics[mean arterial pressure(MAP),heart rate(HR)],cognitive function and safety evaluation were compared between the two groups before operation(T_(0)),2 h after operation(T_(1)),6 h after operation(T_(2)),12 h after operation(T_(3))and 24 h after operation(T4).Results There were 39 cases in the treatment group and 41 cases in the control group.Visual analogue scale(VAS)scores in treatment group and control group were(3.09±0.55)and(3.41±0.62)scores at T_(1);VAS scores were(3.02±0.57)and(3.35±0.48)scores at T_(2);VAS scores were(2.64±0.44)and(2.90±0.46)scores at T3;VAS scores were(2.02±0.41)and(2.35±0.47)scores at T_(4);MMSE scores were(25.28±1.57)and(24.33±1.42)scores at T2;MMSE scores were(28.16±1.01)and(27.25±0.89)scores at T_(4);MoGA scores were(24.63±1.60)and(23.59±1.25)scores at T_(2);MoCA scores were(27.20±0.97)and(26.48±0.83)scores at T4.There were statistically significant differences in the above indexes between the treatment group and the control group(all P<0.05).Adverse drug reactions in the treatment group included bradycardia,hypotension,nausea vomiting and hypokalemia;adverse drug reactions in the control group included bradycardia,hypotension and nausea vomiting.The total incidence rates of adverse drug reactions were 12.82%and 9.76%,without statistically significant difference(P>0.05).Conclusion Compared with using dexmedetomidine alone,parecoxib sodium combined with dexmedetomidine is beneficial for relieving postoperative pain in patients with osteoporotic compression fractures,improving postoperative cognitive function.