帕瑞昔布钠及右美托咪定对老年病人术后认知功能的影响

摘要

Objective:To compare and study the effect of parecoxib sodium and dexmedetomidine on early postoperative cognitive function in elderly patients undergoing abdominal surgery. Methods:90 elderly patients scheduled to undergo abdominal surgery under general anesthesia were randomly divided into three groups, with 30 cases in each group. In the parecoxib sodium group ( P group) , 40 mg parecoxib sodium were given intravenously after the induction of anesthesia, and patients in the dexmedetomidine group ( D group) were given continuous infection of 0. 3 μg/(kg·h)dexmedetomidine after intubation while in the saline group (S group) patients were given a single injection of physiological saline. Cognitive function was evaluated 24 hours before anesthesia, on the 1st, 3rd and 7th post-operative day by using Mini Mental State Examination (MMSE) scale. Results:The MNSE scores in the three groups on the 1st and 3rd postoperative day were significantly lower with respect to baseline characteristics ( P <0. 05). The MMSE scores in Group S were signifi-cantly lower than those in Group P and D on the 1st and 3rd postoperative day ( P <0. 05). The incidence of cognitive dysfunction in Group S was significantly higher than those in the other two groups ( P <0. 05). No significant differences were observed in the MMSE scores and incidences of postoperative cognitive dysfunction between Groups P and D. Conclusions:Dexmedetomidine and parecoxib so-dium have the comparably similar effect in decreasing the incidence of early cognitive dysfunction in elderly patients undergoing abdominal surgery under general anesthesia.%目的:对比研究帕瑞昔布钠及右美托咪定对老年病人腹部手术后早期认知功能的影响. 方法:90例择期全麻下行开腹手术的老年患者,随机分为帕瑞昔布钠组、右美托咪定组和生理盐水组,每组30例患者. 帕瑞昔布纳组于麻醉诱导后静脉注射帕瑞昔布钠40 mg;右美托咪定组于气管插管后静脉持续泵入右美托咪定0. 3 μg/(kg·h);生理盐水组静脉注射等量生理盐水. 采用简易精神状态量表( the Mini Mental State Examination,MMSE)分别于手术前1 d、术后第1 d、3 d、7 d测定患者认知功能评分. 结果:与术前比较,术后第1 d、3 d时,3组患者MMSE评分均降低( P <0. 05),生理盐水组患者术后第1 d、3 d时MMSE评分低于帕瑞昔布纳组和右美托咪定组( P <0. 05). 生理盐水组术后认知功能障碍发生率高于帕瑞昔布纳组和右美托咪定组( P <0. 05). MMSE评分及认知功能障碍发生率在帕瑞昔布纳组和右美托咪定组间比较差异无统计学意义. 结论:帕瑞昔布钠及右美托咪定均能降低老年患者腹部手术后早期认知功能障碍的发生率,两者间比较效果相似.