联合帕瑞昔布钠皮下患者自控镇痛对腹部闭合性损伤患者术后早期认知功能的影响  

Effect of Parecoxib Sodium Combined with Patient-controlled Subcutaneous Analgesia on Early Postoperative Cognitive Function in Patients with Closed Abdominal Injury

作　　者：肖芳 张金立[2] 闫红丽[4] 杨凯 李爱军[2] 李永乐[5] XIAO Fang;ZHANG Jin-li;YAN Hong-li;YANG Kai;LI Ai-jun;LI Yong-le(Department of Anesthesiology,Maternal and Child Health Hospital of Baoding,Baoding,Hebei 071051,China;Department of Anesthesiology,the First Central Hospital of Baoding,Baoding,Hebei 071000,China;Department of Research,Affiliated Hospital of Hebei University,Baoding,Hebei 071000,China;Department of Anesthesiology,Affiliated Hospital of Hebei University,Baoding,Hebei 071000,China)

机构地区：[1]保定市妇幼保健院麻醉科,河北保定071051 [2]保定市第一中心医院麻醉科,河北保定071000 [3]保定市第一中心医院急诊科,河北保定071000 [4]河北大学附属医院科研处,河北保定071000 [5]河北大学附属医院麻醉科,河北保定071000

出　　处：《临床误诊误治》2020年第10期25-30,共6页Clinical Misdiagnosis & Mistherapy

基　　金：河北省医学科学研究重点课题(20170831);保定市科学技术研究与发展指导计划项目(18ZF211)。

摘　　要：目的探讨帕瑞昔布钠联合舒芬太尼皮下患者自控镇痛(patient controlled subcutaneous analgesia,PCSA)对腹部闭合性损伤患者术后早期认知功能的影响。方法选择腹部闭合性损伤行开腹手术患者80例,根据术后PCSA镇痛药物的不同均分为帕瑞昔布钠组及对照组。PCSA药物对照组为舒芬太尼0.9μg/(kg·d)+托烷司琼10 mg+0.9%氯化钠注射液150 ml,帕瑞昔布钠组在对照组基础上加用帕瑞昔布纳120 mg。于麻醉清醒时及术后2、6、12、24 h采用视觉模拟评分(visual analogue scale,VAS)评估两组镇痛效果及术后2 h内、术后2~6 h、术后6~12 h、术后12~24 h镇痛泵按压次数;于术前1 d及术后1、3、7 d应用简易智能精神状态检查量表(mini-mental state examination,MMSE)评估两组认知功能,并观察术后7 d内术后认知功能障碍(postoperative cognitive dysfunction,POCD)发生率;于术前1 d及术后2、12、24 h测定血浆中枢神经特异性蛋白(S100β)、β淀粉样蛋白(Aβ)水平;记录术后7 d内两组药物不良反应发生情况。结果帕瑞昔布钠组术后2、6、12 h VAS评分,术后2 h内、术后2~6 h、术后6~12 h、术后12~24 h镇痛泵按压次数显著低于对照组,差异有统计学意义(P<0.01)。两组术后1、3 d MMSE评分显著低于术前,且帕瑞昔布钠组术后1、3 d MMSE评分显著高于对照组,差异有统计学意义(P<0.01);帕瑞昔布钠组术后7 d内POCD发生率显著低于对照组(P<0.05)。帕瑞昔布钠组术后2、12、24 h血浆S100β水平显著低于对照组,术后2、12 h Aβ水平亦显著低于对照组,差异有统计学意义(P<0.01)。两组术后不良反应比较差异无统计学意义(χ2=0.738,P=0.390)。结论帕瑞昔布钠联合舒芬太尼PCSA用于腹部闭合性损伤术后患者镇痛效果较好,可改善患者术后早期认知功能,降低血浆S100β和Aβ水平,且未增加术后药物不良反应。Objective To investigate the effect of Parecoxib Sodium combined with patient controlled subcutaneous analgesia(PCSA)on early postoperative cognitive function in patients with closed abdominal injury.Methods Eighty patients with closed abdominal injury were selected for open abdominal surgery,and were divided into Parecoxib Sodium group and control group according to the differences of postoperative PCSA analgesics.The PCSA drug of the control group was 0.9μg/(kg·d)Sufentanil,10 mg Tropisetron and 150 ml 0.9%sodium chloride injection,while the PCSA drug of the Parecoxib Sodium group was supplemented with 120 mg PCSA on the basis of the control group.Visual analogue Scale(VAS)was used to evaluate the analgesic effect of the two groups during awake time from anesthesia and at 2,6,12 and 24 h after surgery,and the times of analgesia pump compressions within 2 h,2-6 h,6-12 h,and 12-24 h after operation.Mini-mental State Examination(MMSE)was used to assess cognitive function in the two groups at 1 d before surgery and at 1,3 and 7 d after surgery,and the incidence of postoperative cognitive dysfunction(POCD)in patients at 7 d after surgery was observed.Plasma CNS specific protein(S100β)andβamyloid protein(Aβ)levels were measured at 1 d before and at 2,12,24 h after surgery.The occurrence of adverse drug reactions in the two groups within 7 days after surgery was recorded.Results VAS scores of Parecoxib Sodium group at 2,6 and 12 h after surgery were significantly lower than those of control group.The times of analgesia pump compressions within 2 h,2-6 h,6-12 h and 12-24 h after operation were significantly lower than those of control group(P<0.01).The MMSE scores at 1 and 3 d after surgery were significantly lower in the two groups than those before surgery.Moreover,MMSE scores of the Parecoxib Sodium group were significantly higher than those of control group at 1 and 3 d after operation(P<0.01).POCD incidence in Parecoxib Sodium group was significantly lower than that in control group within 7 days after operat

关 键 词：腹部损伤 皮下自控镇痛 术后认知功能 帕瑞昔布钠 

分 类 号：R826.65[医药卫生—临床医学]