帕瑞昔布钠对老年肝癌肝切除患者术后认知功能的影响  

Effects of parecoxib sodium on cognitive function of elderly patients after hepatectomy for liver cancer

作　　者：骆鹏飞[1] 荚卫东[1] 许戈良[1] 穆夏黎 马金良[1] 葛勇胜[1] 

机构地区：[1]安徽省立医院肝脏外科/肝胆胰外科安徽省重点实验室,安徽合肥230001

出　　处：《中国普通外科杂志》2014年第7期887-892,共6页China Journal of General Surgery

基　　金：国家自然科学基金资助项目(81172364;81201906)

摘　　要：目的:探讨使用帕瑞昔布钠术后镇痛对老年患者肝切除术后认知功能的影响。方法:60岁以上肝癌择期行肝部分切除术患者80例,随机分为观察组及对照组,每组40例。观察组术后使用帕瑞昔布钠(40 mg静脉注射,1次/12 h,连续3 d),对照组使用生理盐水作为安慰剂对照。两组均根据镇痛需要追加药物曲马多使疼痛视觉模糊评分(VAS)不超过3分。使用韦氏成人智力量表(WAⅠS)和韦氏记忆量表(WMS)测试两组患者认知功能障碍(POCD)的发生情况,并检测两组患者术前与术后多个时间点血S-100β蛋白、炎症细胞因子、皮质醇及血氨含量。结果:两组围手术期一般资料差异无统计学意义(均P>0.05)。观察组术后POCD发生率较对照组明显降低(7.5%vs.25.0%,P<0.05)。两组皮质醇、ⅠL-4及血氨术后各时间点与术前比较无明显变化(均P>0.05);两组S-100β蛋白、ⅠL-6、TNF-α、ⅠL-1β、CRP水平在术后不同时间范围内均较术前有不同程度的升高(均P<0.05),但其中观察组术后S-100β蛋白、ⅠL-6水平的升高程度分别在24和48 h内低于对照组(均P<0.05)。结论:帕瑞昔布钠有助于改善老年肝切除患者术后认知功能,机制可能与其降低S-100β和ⅠL-6的水平有关。Objective： To investigate the effects of using parecoxib sodium for analgesia on post-hepatectomy cognitive function in elderly patients. Methods： Eighty patients over 60 years of age undergoing elective hepatectomy for liver cancer were randomly assigned into observational group and control group, with 40 cases in each group. Patients in observational group received parecoxib sodium administration after surgery （40 mg, intravenous injection, and once per 12 h for 3 d） and those in control group were given normal saline as placebo, and additional tramadol was used in either group according to need for analgesia to maintain the pain visual analog scale （VAS） not more than a score of 3. The Wechsler Adult Intelligence Scale （WAIS） and Wechsler Memory Scale （WMS） were used to test the incidence of postoperative cognitive dysfunction （POCD） in both groups of patients, and the blood levels of S-100β protein, inflammatory cytokines, cortisol, and ammonia were detected before surgery and on several time points after surgery. Results： The perioperative data between the two groups of patients showed no statistical difference （all P＆gt;0.05）. The incidence of POCD was significantly lower in observational group than that in control group （7.5% vs. 25%, P＆lt;0.05）. The levels of cortisol, IL-4 and ammonia had no significant alteration in both group at any postoperative time points compared with their preoperative levels （all P＆gt;0.05）; the levels of S-100β protein, IL-6, TNF-α, IL-1β and CRP in both groups were significantly increased in different time spans with varying degrees in both groups compared with their preoperative levels （all P＆lt;0.05）, but the increasing degrees of S-100β protein and IL-6 in observational group were less than those in control group within postoperative 24 and 48 h, respectively （all P＆lt;0.05）.Conclusion： Parecoxib sodium administration can help improve the post-hepatectomy cognitive function in elderly patients, and the mechanism

关 键 词：肝切除术 癌 肝细胞 认知障碍 老年人 

分 类 号：R657.3[医药卫生—外科学]