摘要
目的探讨帕瑞昔布钠对老年腹腔镜手术患者炎性细胞因子及术后认知功能障碍（postoperativec ognitive dysfunction，POCD）的影响。方法择期行腹腔镜胆囊切除术的老年患者80例，年龄≥65岁，美国麻醉医师协会（ASA）分级Ⅰ或Ⅱ级，体重45kg～70k只，性别不限。采用随机数字表法将患者分为两组：帕瑞昔布钠组（P组）和对照组（C组），每组40例。全身麻醉诱导前，P组静脉注射帕瑞昔布钠40mg，c组给予等容量生理盐水。分别于术前24h、术后24h和术后72h采用简易智能状态量表（mini-mental state examination，MMSE）进行患者认知功能评分；分别于诱导前（T0）、切皮后即刻（T1）、二氧化碳气腹后0．5h（T2）、手术结束即刻（L）、术后第1天（T4）、术后第3天（T5）抽取静脉血样，采用酶联免疫吸附剂测定（enzyme linke dimmunosorbent assay，ELISA）检测血清中白细胞介素-6（interleukin-6，IL-6）、肿瘤坏死因子-α（tumor necrosis factor-α，TNF啾）的水平；记录72h内POCD的发生情况。结果与术前24hMMSE评分[c组（28．2±1．2）分、P组（28．8±1．0）分]比较，C组和P组患者术后24h的MMSE评分[（23．0±2．5）、（25．0＋2．8）分]均下降（P〈0．05）；P组[（25．0±2．8）分]术后24h时MMSE评分高于C组[（23．0±2．5）分]（P〈0．05）；P组72h内的POCD发生率较C组低（P〈0．05）。与C组比较，T3-T5时P组血清TNF-α[（11．8±1．7）、（13．8±1．3）、（12．3±1．6）ng几]和IL-6[（40±12）、（48±11）、（50±13）ng／L]浓度降低（P〈0．05）；与R比较，两组T3～T5时血清TNF电和IL-6浓度升高（P〈0．05）。结论帕瑞昔布钠可减少老年腹腔镜胆囊切除患者POCD的发生，其机制可能与抑制炎症反应有关。
Objective To investigate the effect of parecoxib sodium on inflammatory mediator and postoperative cognitive dysfunction （POCD） after laparoscopy surgery in elderly patients. Methods Eighty ASA patients physical status Ⅰ or Ⅱ of both sexes, aged over 65 y, weighing 45 kg-70 kg, undergoing laparoscopic cholecystectomy, were randomly divided into parecoxib sodium （group P, n=40） and control groups （group C, n=40）. The patients in group P were given intravenous parecoxib 40 mg before induction of anesthesia. Ones in group C equal volume normal saline were given instead of parecoxib. Neuropsychological testing was performed with mini-mental state examination （MMSE） on the preoperative day, hh and 3th postoperative day. Venous blood samples were collected before induction of anesthesia （To）, immediately after skin incision （T1）, 30 min after CO2 pneumoperitoneum（T2）, at the end of operation（T3）, the first day of operation（T4）, the third day of operation（T5） for determination of serum concentrations of tumor necrosis factor -α （TNF-α） and interleukin-6 （ IL-6 ） by enzyme linked immunosorbent assay （ ELISA ）. The development of POCD was recorded within 3 days after surgery. Results Compared with preoperative 24 h[group C（28.2±1.2）, group P（28.8±1.0）], the MMSE scores of resting in group C and group P were significantly reduced [ （23.0±.5）, （25.0±2.8）] （P〈0.05）. The MMSE scores of resting in group P more than group C [（25.0±2.8） vs （23.0±2.5）]（P〈0.05）, The development of POCD within 72 h less than group C（P〈0.05）. Compared with group C, the serum concentrations of TNF-α[（11.8±1.7）, （13.8±1.3）, （12.3±1.6） ng/L] and IL-6[ （11.8±1.7）, （13.8±1.3）, （12.3±1.6） ng/L] at T3-T5 were significantly decreased in group P（P〈0.05 ）. Compared with T0,the serum concentrations of TNF-α and IL-6 at T3-T5 were increased in two group（P〈0.05）. Conclusions Parecoxib sodium might decrease the development of POCD in elderly patients undergoing laparoscopic cholecystectomy by inhibition of inflammatory responses.
出处
《国际麻醉学与复苏杂志》
CAS
2015年第6期493-495,501,共4页
International Journal of Anesthesiology and Resuscitation
基金
南通市社会事业科技创新与示范项目（HS2013032）
关键词
老年人
认知障碍
炎性反应
帕瑞昔布钠
Elderly
Cognitive dysfunction
Inflammatory response
Parecoxib sodium
作者简介
通信作者：宋杰，Email：songjie1004@sina．com
