帕瑞昔布钠对老年胃癌根治术后早期认知功能的影响

目的：探讨帕瑞昔布钠对老年胃癌根治术后早期认知功能的影响。方法选择148例行胃癌根治术的老年患者，随机分为观察组和对照组，对照组（74例）在麻醉诱导前30 min给予静脉注射生理盐水5 ml，观察组（74例）在麻醉诱导前30 min给予静脉注射帕瑞昔布钠40 mg，两组患者术后均采用舒芬太尼进行镇痛，应用MMSE量表评估两组患者术前24 h及术后6、24、48 h的认知功能，并检测患者麻醉诱导前、手术结束时、术后6 h、术后24 h的TNF-α、IL-6及S100β含量。结果两组患者术前24 h的MMSE评分差异无统计学意义（P﹥0.05），术后6 h、24 h的MMSE评分均下降，与术前24 h相比差异均有统计学意义（P﹤0.05）。对照组术后48 h的MMSE评分下降，与术前24 h相比差异有统计学意义（P﹤0.05）；观察组术后48 h与术前24 h的MMSE评分比较，差异无统计学意义（P﹥0.05）；对照组术后6、24、48 h的MMSE评分均较观察组低，差异均有统计学意义（P﹤0.05）。两组患者TNF-α、IL-6、S100β术后较术前均上升，且在手术结束时、术后6 h及术后24 h，对照组均较观察组上升更为显著，差异均具有统计学意义（P﹤0.05）。结论帕瑞昔布钠可明显改善老年胃癌根治术后早期认知功能，其机制可能与患者术后炎症反应及神经损伤有关。

Effect of parecoxib sodium on early cognitive function of elderly patients after radical gastrectomy

Objective To discuss the effect of parecoxib sodium on early cognitive function after radical gastrectomy in elderly patients. Method 148 elderly patients who had underwent radical gastrectomy were included in the study and randomized into study group or control group, with 74 cases in each. The patients in control group were given normal sa-line, i.v., 5 ml, 30 minutes before induction of anesthesia, while patients in study group were administered with parecoxib sodium, i.v., 40 mg at the same time, besides, sufentanil was applied for postoperative anesthesia. The cognitive function at 24 h before surgery, and 6 h, 24 h, 48 h after surgery were evaluated using MMSE scale, and the levels of TNF-α, IL-6 and S100β were detected before anesthesia, after surgery, and at 6 h, 12 h, 24 h after surgery for both groups. Result The MMSE scores at 24 h before surgery were similar in the two groups (P>0.05), while significant decreases were ob-served in MMSE scores at 6 h and 24 h after surgery in both groups as compared with those at 24 h before surgery (P<0.05). In control group, the MMSE score at 48 h after surgery was significantly decreased compared with that at 24 h be-fore surgery (P<0.05);While the MMSE at 48 h after surgery was similar with that at 24 h before surgery in study group (P>0.05); Besides, the MMSE score at 6 h, 24 h and 48 h after surgery in control group were lower than those of the study group, with significant differences observed (P<0.05). After surgery, the levels of TNF-α, IL-6, S100βwere all in-creased as compared with before surgery, and higher increases were observed in control group than in study group at 0 h, 6 h and 24 h after surgery (P<0.05). Conclusion Parecoxib sodium ensures significant improve in the early cognitive function after radical gastrectomy for elderly patients, with a possible underlying mechanism which may involve postoper-ative inflammatory response and nerve damage.