Objective To evaluate the effect of dexmedetomidine(DEX)combined with parecoxib sodium(PAX)on post-operative stress and cognitive function in elderly patients undergoing cervical disc herniation surgery.Methods Sixty elderly patients,aged 66-83 yr,ASA Ⅱ-Ⅲ,scheduled for elective cervical disc herniation surgery,were randomly assigned into 3 groups(n=20):control group (group C),DEX group(group D),DEX+PAX group(group DP).In group D,patients were given a load dosage of DEX 0.2 μg· kg-1intravenously within 10 min before anesthesia induction,followed by a continuous infusion of 0.2 μg· kg-1· h-1till 30 min be-fore the end of operation.In group DP,patients were given DEX in accordance with group D,and were given PAX 20 mg at the begin-ning and the end of surgery,respectively.Patients in group C were given the same volume of isotonic saline.The VAS scores were evalu-ated at 1,4,12,24 h after surgery,and dosage of sufentanil,incidence of side effects within 24 h were recorded and evaluated.Pa-tients′cognitive functions were evaluated with mini mental state examination(MMSE)at 1 d before and 4 h(T1),1 d(T2),2 d (T3),3 d(T4)after surgery,and the level of blood glucose(Glu),C-reactive protein(CRP)were detected at the same time.Results The VAS scores in group DP were significantly lower than group C and group D at all time points from 1 to 12 hours after surgery(P<0.05);Glu levels were[(6.6 ±0.1),(6.7 ±0.4),(5.6 ±0.5),(5.4 ±0.2)mmol· L-1,respectively]and CRP levels were [(11.5 ±3.1),(28.3 ±4.2),(24.8 ±4.0),(253.3 ±5.2)mg· L-1,respectively]in group DP at T1 to T4,which were lower than in group C and group D(P<0.05),MMSE scores were[(24.8 ±0.3),(26.9 ±0.8),(27.6 ±0.6),(27.8 ±0.7)points,respec-tively]in group DP at T1 to T4,which was higher than in group C and group D(P<0.05).Conclusions Combined application of DEX and PAX can more effectively inhibit post-operative stress and inflammation,and can improve post-operative cognitive function in elderly patients undergoing cervical disc herniation surgery.%目的 观察右美托咪定(DEX)联合帕瑞昔布钠(PAX)对老年颈椎间盘突出症患者术后应激及认知功能的影响.方法60例择期行手术治疗的颈椎间盘突出症老年患者,年龄66~83岁,美国麻醉医师学会(ASA)Ⅱ或Ⅲ级,按随机数字表分为3组,每组20例:对照组(C组)、DEX(D组)、DEX+PAX(DP组).D组在诱导前静脉泵入DEX负荷量0.2 μg· kg-1,输入时间10 min,接着以0.2 μg· kg -1· h-1维持,手术结束前30 min停止.DP组泵入DEX(同D组),分别于手术开始和结束前10 min静脉注射帕瑞昔布钠20 mg.C组仅给予等量生理盐水.评估术后1、4、12、24 h视觉模拟(VAS)疼痛评分,24 h内舒芬太尼用量及不良反应情况.于术前1 d(T0)、术后4 h(T1)、1 d(T2)、2 d(T3)、3 d(T4)时,评估简易精神状态量表(MMSE)评分,在T0~T4时采集静脉血检测血浆葡萄糖(Glu)和C-反应蛋白(CRP)浓度.结果 在术后1~12 h各时点,DP组VAS评分明显低于C组和D组(P<0.05);在T1~T4时,DP组Glu[(6.6 ±0.1)、(6.7 ±0.4)、(5.6 ±0.5)、(5.4 ±0.2)mmol· L-1]和CRP[(11.5 ±3.1)、(28.3 ±4.2)、(24.8 ±4.0)、(253.3 ±5.2)mg· L-1]明显低于C组和D组(P<0.05),DP组MMSE评分[(24.8 ±0.3)、(26.9 ±0.8)、(27.6 ±0.6)、(27.8 ±0.7)分]明显高于C组和D组(P<0.05).结论 联合应用小剂量DEX和PAX能更有效抑制老年颈椎间盘突出症患者术后炎症和应激,改善术后认知功能.
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