CAJ | 학술논문

目的探讨帕瑞昔布钠围手术期镇痛对老年急症股骨头置换术患者血清神经元特异性烯醇化酶(NSE)、S-100β蛋白浓度与术后谵妄(POD)、术后认知功能障碍(POCD)发生率的影响.方法经医院伦理学委员会同意并与患者家属签订知情同意书,选择2011年1月至2012年5月在青岛市市立医院与海慈医疗集团骨科腰麻-硬膜外联合麻醉下急诊股骨头置换术患者80例,年龄＞70岁,随机数字法分为2组(n=40):吗啡组(C组)及帕瑞昔布钠组(P组).P组采用帕瑞昔布钠20 mg或40 mg(体质量50 kg为依据)静脉注射镇痛,每12h1次,连续6次；C组首次静脉注射吗啡2 mg或4 mg作为对照.2组均额外每次追加吗啡2 mg使患者疼痛视觉模拟评分达3分以下.主要观察指标:(1)2组术后住院时间,吗啡追加量；(2)2组POD的发生率与术后3 d(T1)、1周(T2)、3个月(T3)及6个月(T4)患者POCD的发生率；(3)2组各随机抽取20例于采取镇痛措施前(t0)、麻醉前(t1)、术毕(t2)、术后6 h(t3)、24 h(t4)及48 h(t5)检测血清神经元特异性烯醇化酶(NSE)、S-100β蛋白浓度；(4)其他严重并发症.结果与C组相比较,P组吗啡追加量及术后住院时间降低[(7.9±2.6) mg比(31.3±3.9)mg,(11.4±1.5)d比(12.3±1.6)d,均P＜0.05];P组POD及T1～T4 POCD发生率降低(22.5％比45％,17.5％、12.5％、7.5％、2.5％比37.5％、32.5％、25％、17.5％,均P ＜0.05)；P组血清NSE浓度在t2 ～t5时降低[(7.1±2.7) μg/L、(9.5±3.6)μg/L、(8.4±3.6) μg/L、(7.2±2.8)μg/L比(9.4±4.1)μg/L、(13.6±5.0) μg/L、(11.1±3.7) μg/L、(9.4±3.3) μg/L,均P＜0.05],血清S-100β蛋白浓度在t1～t5时降低[(0.61 ±0.27) μg/L、(0.99±0.38) μg/L、(0.73±0.25) μg/L、(0.65±0.28) μg/L、(0.87±0.32) μg/L比(0.83±0.36) μg/L、(1.48±0.57) μg/L、(0.98 ±0.37)μg/L、(0.88±0.29) μg/L、(1.12 ±0.45) μg/L,均P＜0.05],其他时间点2组比较差异无统计学意义(P＞0.05)；2组均无严重并发症发生.结论帕瑞昔布钠围手术期镇痛减轻中枢神经系统损伤,改善老年患者术后认知功能,利于患者康复. 目的探討帕瑞昔佈鈉圍手術期鎮痛對老年急癥股骨頭置換術患者血清神經元特異性烯醇化酶(NSE)、S-100β蛋白濃度與術後譫妄(POD)、術後認知功能障礙(POCD)髮生率的影響.方法經醫院倫理學委員會同意併與患者傢屬籤訂知情同意書,選擇2011年1月至2012年5月在青島市市立醫院與海慈醫療集糰骨科腰痳-硬膜外聯閤痳醉下急診股骨頭置換術患者80例,年齡＞70歲,隨機數字法分為2組(n=40):嗎啡組(C組)及帕瑞昔佈鈉組(P組).P組採用帕瑞昔佈鈉20 mg或40 mg(體質量50 kg為依據)靜脈註射鎮痛,每12h1次,連續6次；C組首次靜脈註射嗎啡2 mg或4 mg作為對照.2組均額外每次追加嗎啡2 mg使患者疼痛視覺模擬評分達3分以下.主要觀察指標:(1)2組術後住院時間,嗎啡追加量；(2)2組POD的髮生率與術後3 d(T1)、1週(T2)、3箇月(T3)及6箇月(T4)患者POCD的髮生率；(3)2組各隨機抽取20例于採取鎮痛措施前(t0)、痳醉前(t1)、術畢(t2)、術後6 h(t3)、24 h(t4)及48 h(t5)檢測血清神經元特異性烯醇化酶(NSE)、S-100β蛋白濃度；(4)其他嚴重併髮癥.結果與C組相比較,P組嗎啡追加量及術後住院時間降低[(7.9±2.6) mg比(31.3±3.9)mg,(11.4±1.5)d比(12.3±1.6)d,均P＜0.05];P組POD及T1～T4 POCD髮生率降低(22.5％比45％,17.5％、12.5％、7.5％、2.5％比37.5％、32.5％、25％、17.5％,均P ＜0.05)；P組血清NSE濃度在t2 ～t5時降低[(7.1±2.7) μg/L、(9.5±3.6)μg/L、(8.4±3.6) μg/L、(7.2±2.8)μg/L比(9.4±4.1)μg/L、(13.6±5.0) μg/L、(11.1±3.7) μg/L、(9.4±3.3) μg/L,均P＜0.05],血清S-100β蛋白濃度在t1～t5時降低[(0.61 ±0.27) μg/L、(0.99±0.38) μg/L、(0.73±0.25) μg/L、(0.65±0.28) μg/L、(0.87±0.32) μg/L比(0.83±0.36) μg/L、(1.48±0.57) μg/L、(0.98 ±0.37)μg/L、(0.88±0.29) μg/L、(1.12 ±0.45) μg/L,均P＜0.05],其他時間點2組比較差異無統計學意義(P＞0.05)；2組均無嚴重併髮癥髮生.結論帕瑞昔佈鈉圍手術期鎮痛減輕中樞神經繫統損傷,改善老年患者術後認知功能,利于患者康複.
목적 탐토파서석포납위수술기진통대노년급증고골두치환술환자혈청신경원특이성희순화매(NSE)、S-100β단백농도여술후섬망(POD)、술후인지공능장애(POCD)발생솔적영향.방법 경의원윤리학위원회동의병여환자가속첨정지정동의서,선택2011년1월지2012년5월재청도시시립의원여해자의료집단골과요마-경막외연합마취하급진고골두치환술환자80례,년령＞70세,수궤수자법분위2조(n=40):마배조(C조)급파서석포납조(P조).P조채용파서석포납20 mg혹40 mg(체질량50 kg위의거)정맥주사진통,매12h1차,련속6차；C조수차정맥주사마배2 mg혹4 mg작위대조.2조균액외매차추가마배2 mg사환자동통시각모의평분체3분이하.주요관찰지표:(1)2조술후주원시간,마배추가량；(2)2조POD적발생솔여술후3 d(T1)、1주(T2)、3개월(T3)급6개월(T4)환자POCD적발생솔；(3)2조각수궤추취20례우채취진통조시전(t0)、마취전(t1)、술필(t2)、술후6 h(t3)、24 h(t4)급48 h(t5)검측혈청신경원특이성희순화매(NSE)、S-100β단백농도；(4)기타엄중병발증.결과 여C조상비교,P조마배추가량급술후주원시간강저[(7.9±2.6) mg비(31.3±3.9)mg,(11.4±1.5)d비(12.3±1.6)d,균P＜0.05];P조POD급T1～T4 POCD발생솔강저(22.5％비45％,17.5％、12.5％、7.5％、2.5％비37.5％、32.5％、25％、17.5％,균P ＜0.05)；P조혈청NSE농도재t2 ～t5시강저[(7.1±2.7) μg/L、(9.5±3.6)μg/L、(8.4±3.6) μg/L、(7.2±2.8)μg/L비(9.4±4.1)μg/L、(13.6±5.0) μg/L、(11.1±3.7) μg/L、(9.4±3.3) μg/L,균P＜0.05],혈청S-100β단백농도재t1～t5시강저[(0.61 ±0.27) μg/L、(0.99±0.38) μg/L、(0.73±0.25) μg/L、(0.65±0.28) μg/L、(0.87±0.32) μg/L비(0.83±0.36) μg/L、(1.48±0.57) μg/L、(0.98 ±0.37)μg/L、(0.88±0.29) μg/L、(1.12 ±0.45) μg/L,균P＜0.05],기타시간점2조비교차이무통계학의의(P＞0.05)；2조균무엄중병발증발생.결론 파서석포납위수술기진통감경중추신경계통손상,개선노년환자술후인지공능,리우환자강복.
Objective To explore the effects of parecoxib sodium analgesia on serum concentrations of neuron-specific enolase (NSE) and S-100β and postoperative cognitive function of elderly patients undergoing acute replacement of femoral head.Methods After the approval of institutional review board and the provision of informed consent,80 patients over 70 years old,undergoing acute replacement of femoral head under combined spinal and epidural anesthesia and midazolam sedation at Qingdao Municipal Hospital and Qingdao Hiser Medical Center from January 2011 to May 2012,were randomly assigned into control group (group C,n =40) and parecoxib group (group P,n =40).In group P,parecoxib sodium 20/ 40 mg (based on weight 50 kg) was administered via an intravenous injection after admission with 12 hours intervals for six times.In group C,morphine 2/4 mg was given initially.Additional morphine 2 mg was given to maintain the pain visual analog scale (VAS) of 3 points or less in both groups.Primary observation indices:(1) postoperative time and additional amount of morphine; (2) rate of postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) at 3 days,1 week,3 months and 6 months postoperation (T1-T4) ; (3) serum levels of NSE and S-1005 were measured at the timepoints of before analgesia (t0),before anesthesia (t1),end of surgery (t2) and 6 hours,24 hours,48 hours postoperation (t3-t5); (4) other serious complications.Results Compared with group C,the additional amount of morphine,postoperative time,rate of POD and POCD at T1-T4,the level of NSE at t2-t5 and S-100 β at t1-t5 were lower in group P (P ＜0.05).No other serious complications were observed.Conclusions Parecoxib sodium analgesia reduces the rate of POD and POCD in elderly patients with neuroprotective effects.