氟比洛芬酯和帕瑞昔布钠不同给药时机对老年妇科子宫全切术术后镇痛及认知功能的影响  

Comparison of the effects of different dosing time of flurbiprofen ester and parecoxib sodium on analgesia and cognitive function in elderly women after laparoscopic surgery

作　　者：康凯[1] 王玥[1] 卓亚[1] 刘野[1] 李杉[1] 黄海凝[1] 

机构地区：[1]首都医科大学附属北京妇产医院麻醉科,北京100026

出　　处：《海南医学》2017年第10期1578-1581,共4页Hainan Medical Journal

基　　金：首都医科大学附属北京妇产医院中青年学科骨干培养专项基金(编号:fcyy201426)

摘　　要：目的比较不同时机给予氟比洛芬酯和帕瑞昔布钠对老年妇科子宫全切手术后镇痛及认知功能的影响。方法选取2015年3月至2016年3月在首都医科大学附属北京妇产医院全麻下行择期子宫全切术的老年女性患者80例,按随机数字表法分为四组,其中全麻插管后给予氟比洛芬酯(50 mg)为F1组、术毕前30 min给予氟比洛芬酯(50 mg)为F2组、全麻插管后给予帕瑞昔布钠(40 mg)为P1组、术毕前30 min给予帕瑞昔布钠(40 mg)为P2组,每组各20例。记录诱导前(T0)、气管插管后10 min(T1)、手术30 min(T2)、术毕(T3)、拔管(T4)、拔管后10 min(T5)的心率(HR)及平均动脉压(MAP),记录术后6 h、12 h及24 h的VAS疼痛评分以及各组T5时点的Ramsay镇静及Riker-SAS躁动评分,采用简易精神状态检查表(MMSE)评价术前、术后24 h、72 h的认知功能障碍情况。结果 T2、T3时点F1组患者的MAP和HR明显低于P1组,T5时点P1组患者的MAP和HR低于F1组,差异均有统计学意义(P<0.05);四组患者在T5时点的镇静和躁动评分比较差异均无统计学意义(P>0.05);与术前24 h比较,四组患者术后24 h的MMSE评分均下降,差异均有统计学意义(P<0.05);与F2和P2组比较,F1和P1组24 h时MMSE评分升高,术后72 h内认知功能障碍发生率较低,差异均有统计学意义(P<0.05)。结论两种非甾体类镇痛药均可以降低认知功能障碍的发生率,在插管后给予帕瑞昔布钠用于术后镇痛优势更加明显。Objective To compare the different timing for flurbiprofen ester and parecoxib sodium analgesia for total hysterectomy in the elderly and the influence of cognitive function. Methods A total of 80 cases of elderly women scheduled for total hysterectomy under general anesthesia in our hospital from Mar. 2015 to Mar. 2016 were ran-domly divided into four groups：F1 group （giving flurbiprofen ester 50 mg after general anesthesia intubation;F2 group （giving flurbiprofen ester 50 mg 30 min before operation）;P1 group （giving parecoxib sodium 40 mg after general anes-thesia intubation）;P2 group （giving parecoxib sodium 40 mg 30 min before operation）;with 20 cases in each group. The heart rate （HR） and mean arterial pressure （MAP） of the patients were recorded before induction （T0）, 10 min after endo-tracheal intubation （T1）, 30 min before surgery （T2）, after operation （T3）, tube drawing （T4） and 10 min after tube draw-ing （T5）. VAS pain scores were recorded at 6 h, 12 h and 24 h postoperatively. Ramsay sedation score and Riker-SAS ag-itation score of each group at T5 were also recorded. The preoperative and postoperative cognitive dysfunction of 24 h and 72 h were recorded using MMSE. Results The MAP and HR at T2 and T3 in F1 group was significantly lower than those in P1 group （P〈0.05）;the MAP and HR at T5 in P1 group was significantly lower than those in F1 group （P〈0.05）. There was no significant difference in Ramsay sedation score and Riker-SAS agitation score between the four groups at T5 （P〉0.05）. Compared with preoperative 24 h, the MMSE scores of the four groups were significantly de-creased 24 h after operation （P〈0.05）. Compared with the F2 and P2 groups, the MMSE scores were significantly higher in the F1 and P1 groups 24 h after operation, and the incidences of postoperative cognitive dysfunction （POCD） were lower 72 h after operation （P〈0.05）. Conclusion The two non-steroidal analgesics are both effective in reducing the in-cid

关 键 词：非甾体镇痛药 子宫全切术 术后镇痛 认知障碍 

分 类 号：R619[医药卫生—外科学]