帕瑞昔布钠超前镇痛联合舒芬太尼术后镇痛对老年患者术后早期认知功能的影响

目的探讨帕瑞昔布钠超前镇痛联合舒芬太尼术后镇痛对老年胸科手术患者术后早期认知功能的影响。方法选择于胸腔镜下行肺癌根治术的患者60例,男33例,女27例,年龄65~75岁,美国麻醉医师协会(ASA)分级Ⅰ~Ⅱ级,体重50~70 kg。采用随机数字表法将患者随机分为帕瑞昔布钠组及对照组,每组30例。帕瑞昔布钠组:麻醉诱导后静脉滴注帕瑞昔布钠40 mg(用生理盐水稀释至5 mL);对照组:麻醉诱导后静脉滴注同等容量的生理盐水5 mL。所有患者术后均使用静脉自控镇痛(PCIA),药物:舒芬太尼2μg/kg及盐酸雷莫司琼0.6 mg。于术后2、12、24 h采用视觉模拟评分法(VAS)进行疼痛评分,术后维持VAS评分≤3分。若VAS评分>3分,可按压术后镇痛泵单次给药直到疼痛缓解。使用简易智力状态监测量表(MMSE),分别于术前1 d及术后2、12、24 h进行认知功能评估。记录术后认知功能障碍发生情况及舒芬太尼消耗量。结果与对照组比较,帕瑞昔布钠组术后认知功能障碍发生率降低,术后2、12、24 h MMSE评分均较低,差异有统计学意义(P<0.05)。帕瑞昔布钠组的术后2、12、24 h VAS评分、按压术后镇痛泵次数及舒芬太尼总消耗量均低于C组,差异有统计学意义(P<0.05),且术后呼吸抑制、恶心呕吐等不良反应发生率低于C组(P<0.05)。结论帕瑞昔布钠超前镇痛联合舒芬太尼术后镇痛能有效减轻老年胸科手术患者术后疼痛,且帕瑞昔布钠超前镇痛能降低老年患者术后早期认知功能的发生风险,减少术后镇痛阿片类药物用量,降低不良反应发生率。

Effect of preemptive analgesia with parecoxib sodium combined with sulfentanyl postoperative analgesia on early cognitive function in elderly patients after operation

Objective To investigate the effect of preemptive analgesia with parecoxib sodium combined with sulfentanyl analgesia on postoperative cognitive function in elderly patients undergoing thoracic surgery. Methods Six-ty ASAⅠ~Ⅱ patients aged 65~75 years undergoing lung resection were randomly divided into two groups:parecox-ib group (n=30) and control group (n=30). Parecoxib sodium (40 mg) + normal saline (5 mL) was injected in-travenously after anesthesia induction in parecoxib group;same volume saline was injected intravenously after anesthesia induction in control group. Patient-controlled intravenous analgesia with sulfentanyl 2 μg/kg and ramosetron hydrochlo-ride 0. 6 mg was used. At 2 h,12 h and 24 h after operation,the pain score was evaluated by VAS score which should be less than 3;if VAS score>3,a bolus of PCIA was allowed until the analgesia was relieved. Cognitive function was assessed by Mini-Mental state examination ( MMSE) at 1 d before operation and 2 h,12 h and 24 h after operation. The total amount of sulfentanyl was recorded. Results Compared with control group,the incidence of postoperative cogni-tive dysfunction in parecoxib group was lower (P<0. 05),and the MMSE scores at 2 h,12 h and 24 h after operation decreased more significantly (P<0. 05). The number of patients who pressed the postoperative analgesia pump in pare-coxib group was less than that of control group with lower total amount of sulfentanyl and VAS score at 2 h,12 h and 24 h after operation (P<0. 05). The incidence of adverse reaction (such as respiratory depression,nausea and vomi-ting) in parecoxib group was lower than that of control group (P<0. 05). Conclusion Parecoxib sodium preemptive analgesia combined with sulfentanyl postoperative analgesia can effectively relieve the postoperative pain of elderly pa-tients undergoing lung resection. Parecoxib sodium preemptive analgesia can reduce the risk of early period POCD and postoperative sulfentanyl consumption,and decrease the incidence of adverse reaction.