塞来昔布防治老年髋部骨折PTSD效果及对精神心理行为影响研究  

Study on the effect of celecoxib on the prevention and treatment of PTSD and the influences of psychosocial behavior in elderly patients with hip fractures

作　　者：李平 肖楸钶 卢卫忠[1] 代震宇[1] LI Ping;XIAO Qiuke;LU Weizhong;DAI Zhenyu(Department of Orthopeadics,Chongqing Traditional Chinese Medicine Hospital,Chongqing 400021,China)

机构地区：[1]重庆市中医院骨伤科,重庆400021

出　　处：《现代医药卫生》2021年第9期1437-1441,共5页Journal of Modern Medicine & Health

基　　金：重庆市卫生健康委员会高端后备人才项目(2017HBRC012)。

摘　　要：目的观察塞来昔布对老年髋部骨折患者可能发生的创伤后应激障碍(PTSD)的防治作用及精神心理行为的影响。方法收集该院2018年1月至2020年6月骨科老年(≥65岁)髋部骨折患者120例,随机均分为A、B、C三组,各40例。其中A组为塞来昔布高剂量试验组(口服塞来昔布0.2 g,每天2次,连续4周);B组为塞来昔布低剂量试验组(口服塞来昔布0.2 g,每天1次,连续4周);C组为空白对照组(口服安慰剂,每天2次,连续4周)。入院后第1、2、4周分别检测各组患者血液中白细胞介素-1(IL-1)、IL-6水平;入院后第4、24周,分别利用PTSD筛查量表(PCL-C)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD),观察对比各组患者PTSD发病率,并进行精神心理行为随访。结果三组患者在入院后第1、4周时IL-1、IL-6水平比较,差异均无统计学意义(P>0.05);入院第2周时,A、B组IL-1、IL-6水平较C组明显下降,差异均有统计学意义(P<0.05)。入院第4周,A、B、C组有一定程度PTSD症状的发生率分别为15.0%(6/40)、22.5%(9/40)、20.0%(8/40),各组均无明显PTSD症状患者;三组患者PCL-C、HAMA、HAMD得分比较,差异均无统计学意义(P>0.05)。入院第24周,A、B、C组有一定程度PTSD症状的发生率分别为0、0、10.0%(4/40),三组均无明显PTSD症状患者;A、B组患者PCL-C、HAMA、HAMD总分及各因子得分均低于C组,且差异均有统计学意义(P<0.05)。结论塞来昔布可以有效缓解老年髋部骨折患者应激症状及焦虑、抑郁不良情绪,但无剂量相关性。Objective To observe the effect of celecoxib on the prevention and treatment of PTSD and the influences of psychosocial behavior in elderly patients with hip fractures.Methods A total of 120 elderly orthopedic patients(≥65 years old)with hip fracture from January 2018 to June 2020 in the hospital were collected and randomly divided into group A,group B and group C,40 cases in each group.Group A was high-dose experimental group(oral celecoxib 0.2 g,2 times a day,for 4 weeks);group B was celecoxib low-dose experimental group(oral celecoxib 0.2 g,once a day,for 4 weeks);group C was the blank control group(oral placebo,2 times a day,for 4 weeks).The levels of Interleukin-1(IL-1)and IL-6 in each group were measured at 1,2 and 4 weeks after admission.At week 4 and week 24 after admission,the incidence of post-traumatic stress disorder(PTSD),Hamilton Anxiety Scale(HAMA)and Hamilton Depression Scale(HAMD)were used to observe and compare the incidence of post-traumatic stress disorder(PTSD)and conduct mental and psychological behavior follow-up.Results There was no significant difference in the levels of IL-1 and IL-6 between the three groups in the first and fourth weeks after admission(P>0.05);at the second week after admission,the levels of IL-1 and IL-6 in groups A and B were significantly lower than those in group C,and the differences were statistically significant(P<0.05).In the 4th week of admission,the incidence of PTSD symptoms to a certain degree in groups A,B and C was 15.0%(6/40),22.5%(9/40)and 20.0%(8/40),respectively,and there was no patients with obvious symptoms of PTSD in three groups.There was no statistically significant difference in the scores of PCL-C,HAMA and HAMD among the three groups(P>0.05).At the 24th week of admission,the incidence of PTSD symptoms to a certain degree in groups A,B,and C was 0,0,and 10.0%(4/40),respectively.All three groups had no obvious PTSD symptoms.The total scores and factors scores of PCL-C of patients in groups A and B,HAMA,and HAMD were lower than those in group C,a

关 键 词：塞来昔布 环氧化酶-2抑制剂 创伤后应激障碍 炎症介质 骨折 

分 类 号：R68[医药卫生—骨科学] R395[医药卫生—外科学]