帕瑞昔布钠镇痛对老年急诊股骨头置换术患者神经系统的影响  

Effects of parecoxib sodium analgesia on serum concentrations of neuron-specific enolase and S-100β and postoperative cognitive function of elderly patients undergoing acute replacement of femoral head

作　　者：李井柱[1] 李晓征 王晓敏 王明山[1] 于海芳 时飞[1] 苗丹[4] 毕燕琳[1] 

机构地区：[1]青岛市市立医院(东院)麻醉科,山东省266071 [2]青岛市海慈医疗集团麻醉科 [3]青岛市海慈医疗集团药剂科 [4]青岛市市立医院(东院)神经内科,山东省266071

出　　处：《中华医学杂志》2013年第27期2152-2154,共3页National Medical Journal of China

基　　金：青岛市科技局科技发展计划资助项目（10-3-3-4-8-nsh）

摘　　要：目的探讨帕瑞昔布钠围手术期镇痛对老年急症股骨头置换术患者血清神经元特异性烯醇化酶（NSE）、S-10013蛋白浓度与术后谵妄（POD）、术后认知功能障碍（POCD）发生率的影响。方法经医院伦理学委员会同意并与患者家属签订知情同意书，选择2011年1月至2012年5月在青岛市市立医院与海慈医疗集团骨科腰麻一硬膜外联合麻醉下急诊股骨头置换术患者80例，年龄〉70岁，随机数字法分为2组（n=40）：吗啡组（c组）及帕瑞昔布钠组（P组）。P组采用帕瑞昔布钠20mg或40mg（体质量50蚝为依据）静脉注射镇痛，每12h1次，连续6次；C组首次静脉注射吗啡2mg或4mg作为对照。2组均额外每次追加吗啡2mg使患者疼痛视觉模拟评分达3分以下。主要观察指标：（1）2组术后住院时间，吗啡追加量；（2）2组POD的发生率与术后3d（T1）、1周（T2）、3个月（T3）及6个月（T4）患者POCD的发生率；（3）2组各随机抽取20例于采取镇痛措施前（t0）、麻醉前（t1）、术毕（t2）、术后6h（t3）、24h（t4）及48h（t5）检测血清神经元特异性烯醇化酶（NSE）、S-10013蛋白浓度；（4）其他严重并发症。结果与C组相比较，P组吗啡追加量及术后住院时间降低[（7．9±2．6）mg比（31．3±3．9）mg，（11．4±1．5）d比（12．3±1．6）d，均P〈0．051．P组POD及T1-T4POCD发生率降低（22．5％比45％，17．5％、12．5％、7．5％、2．5％比37．5％、32．5％、25％、17．5％，均P〈0．05）；P组血清NSE浓度在t2～t5时降低[（7．1±2．7）μg/L、（9．5±3．6）μg/L、（8．4±3．6）μg/L、（7．2±2．8）μg/L比（9．4±4．1）μg/L、（13．6±5．0）μg/L、（11．1±3．7）μg/L、（9．4±3．3）μg/L，均P〈0．05]，血清S-100p蛋白浓度在t，～t5时降低[（0．61±0．27）μg/L、（0．99±0．38）μg/L、（0．73±0．25）μg/L、（0．65±0．28）μg/L、（0．8Objective To explore the effects of parecoxib sodium analgesia on serum concentrations of neuron-specific enolase （NSE） and S-100β and postoperative cognitive function of elderly patients undergoing acute replacement of femoral head. Methods After the approval of institutional review board and the provision of informed consent, 80 patients over 70 years old, undergoing acute replacement of femoral head under combined spinal and epidural anesthesia and midazolam sedation at Qingdao Municipal Hospital and Qingdao Hiser Medical Center from January 2011 to May 2012, were randomly assigned into control group （ group C, n = 40 ） and parecoxib group （ group P, n = 40）. In group P, parecoxib sodium 20/ 40 mg （based on weight 50 kg） was administered via an intravenous injection after admission with 12 hours intervals for six times. In group C, morphine 2/4 mg was given initially. Additional morphine 2 mg was given to maintain the pain visual analo scale （VAS） of 3 points or less in both rouDs. Primary observation indices： （1） postoperative time and additional amount of morphine; （2） rate of postoperative delir/um （POD） and postoperative cognitive dysfunction （POCD） at 3 days, 1 week, 3 months and 6 months postoperation （TI -T4 ） ; （3） serum levels of NSE and S-10013 were measured at the timepoints of before analgesia （ to ）, before anesthesia （ t1 ）, end of surgery （ t2 ） and 6 hours, 24 hours, 48 hours postoperation （t3 -t5 ）; （4） other serious complications. Results Compared with group C, the additional amount of morphine, postoperative time, rate of POD and POCD at Tl -T4, the level of NSE at t2 -t5 and S-10013 at t1 -t5 were lower in group P （P 〈0. 05）. No other serious complications were observed. Conclusions Parecoxib sodium analgesia reduces the rate of POD and POCD in elderly patients with neuroprotective effects.

关 键 词：老年人 认知障碍 磷酸丙酮酸水合酸酶 帕瑞昔布钠 

分 类 号：R614[医药卫生—麻醉学]