摘要
目的探讨帕瑞昔布钠对老年腹腔镜胆囊切除术患者全身麻醉术后疼痛和认知功能的影响。方法选择2017年1月至2019年12月在新疆医科大学第一附属医院行腹腔镜胆囊切除术的老年患者90例为研究对象,按照随机数字表法将其分为对照组和研究组,每组各45例。两组患者均行常规麻醉诱导、气管插管、机械通气、麻醉维持,对照组患者于麻醉诱导前20 min静脉推注生理盐水,研究组患者于麻醉诱导前20 min静脉推注帕瑞昔布钠。比较两组患者术后疼痛情况、血清疼痛相关递质和炎性因子水平、认知功能障碍和不良反应发生情况。结果拔管后5 min、1 h、6 h,研究组患者视觉模拟评分法评分均显著低于同期对照组(均P<0.05)。研究组患者术后24 h血清P物质、5-羟色胺水平均显著低于对照组(均P<0.05),血清γ-氨基丁酸、β-内啡肽水平均显著高于对照组(均P<0.05)。术后24 h、72 h,研究组患者简易精神状态检查量表评分均显著高于同期对照组(均P<0.05),术后认知功能障碍发生率显著低于对照组(P<0.05)。切皮后即刻、术后第1天、术后第3天,研究组患者血清肿瘤坏死因子-α和白介素-6水平均显著低于同期对照组(均P<0.05)。研究组患者恶心/呕吐、寒战、烦躁、无法耐受导尿管等不良反应发生率均显著低于对照组(均P<0.05)。结论帕瑞昔布钠能减轻老年腹腔镜胆囊切除术患者术后疼痛、炎性反应程度,调节血清疼痛相关递质水平,减少认知功能障碍与不良反应。
Objective To investigate the effects of parecoxib sodium on postoperative pain and cognitive function in elderly patients undergoing laparoscopic cholecystectomy under general anesthesia.Method From January 2017 to December 2019,90 elderly patients scheduled for laparoscopic cholecystectomy in the First Affiliated Hospital of Xinjiang Medical University were selected as the research objects,they were divided into two groups according to the random number table method,with 60 cases in each group.Both groups received routine anesthesia induction,endotracheal intubation,mechanical ventilation and anesthesia maintenance,Patients in control group were injected with normal saline 20 min before anesthesia induction;and patients in study group were injected with parecoxib 20 min before anesthesia induction.The postoperative pain condition,serum levels of pain related neurotransmitters and inflammatory factors as well as the incidence of cognitive dysfunction and adverse reactions were compared between the two groups.Result The visual analogue scale(VAS)score of study group at 5 min,1 h and 6 h after extubation were significantly lower than those of control group at the corresponding time(all P<0.05).The levels of serum substance P(PS)and 5-hydroxytryptamine(5-HT)at 24 h after operation in study group were significantly lower than those in control group(all P<0.05),and the levels of serum γ-aminobutyric acid(GABA)and β-endorphin(β-EP)were significantly higher than those in control group(all P<0.05).The mini mental state examination(MMSE)scale score of study group at 24 h and 72 h after operation were significantly higher than those of control group at the corresponding time(all P<0.05),and the incidence of postoperative cognitive dysfunction in study group was significantly lower than that in control group(P<0.05).The levels of serum tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)immediately after skin incision,on the 1st day and 3rd day after operation in study group were significantly lower than those in control group at the corresponding time(all P<0.05).The incidence of nausea/vomiting,chills,irritability,and intolerance of catheter in study group were significantly lower than those in control group(all P<0.05).Conclusion Parecoxib sodium can reduce the degree of postoperative pain and inflammation in elderly patients undergoing laparoscopic cholecystectomy,regulate the levels of serum pain related neurotransmitters,and reduce cognitive dysfunction and adverse reactions.
作者
谷申森
李芳
赵萍
曹峻
Gu Shensen;Li Fang;Zhao Ping;Cao Jun(Laparoscopic Surgery of the Liver,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China;Surgery of Hepatobiliary Hydatid,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)
出处
《中国医学前沿杂志（电子版）》
2021年第6期48-52,共5页
Chinese Journal of the Frontiers of Medical Science(Electronic Version)
基金
新疆维吾尔自治区卫生健康委员会适宜技术推广项目(SYTG-202013)。
关键词
帕瑞昔布钠
腹腔镜胆囊切除术
老年
疼痛
认知功能
Parecoxib sodium
Laparoscopic cholecystectomy
Elderly
Pain
Cognitive function
