Protective efficacy of combined use of parecoxib and dexmedetomidine on postoperative hyperalgesia and early cognitive dysfunction after laparoscopic cholecystectomy for elderly patients

Abstract Purpose: To investigate efficacy of combined use of parecoxib and dexmedetomidine on postoperative pain and early cognitive dysfunction after laparoscopic cholecystectomy for elderly patients. Methods: The present prospective randomized controlled study included a total of 80 patients who underwent laparoscopic cholecystectomy surgery during January 2016 to November 2017 in our hospital. All patients were randomly divided into 4 groups, the parecoxib group, the dexmedetomidine group, the parecoxib and dexmedetomidine combined group, and the control group. Demographic data and clinical data were collected. Indexes of heart rate (HR), mean arterial pressure (MAP), levels of jugular venous oxygen saturation (SjvO2) and jugular venous oxygen pressure (PjvO2) were recorded at different time points before and during the surgery. The mini-mental state examination (MMSE) score, Ramsay score and Visual Analogue Score (VAS) were measured. Results: Levels of both SjvO2 and PjvO2 were significantly higher in parecoxib group, dexmedetomidine group and the combined group than the control group. Meanwhile, levels of both SjvO2 and PjvO2 in the combined group were the highest. VAS scores were significantly lower in the combined group than all other groups, and total patient controlled intravenous analgesia (PCIA) pressing times within 48 h after surgery were the lowest in the combined group. Both Ramsay and MMSE scores were the highest in the combined group compared with other groups, while were the lowest in the control group. Conclusion: The combined use of parecoxib and dexmedetomidine could reduce the postoperative pain and improve the postoperative sedation and cognitive conditions of patients after laparoscopic cholecystectomy.

摘要 目的：探讨帕瑞昔布钠(parecoxib)联合右美托咪定(dexmedetomidine)对老年患者腹腔镜胆囊切除术(laparoscopic cholecystectomy)后术后疼痛与早期认知功能障碍的疗效。方法：本前瞻性随机对照研究纳入2016年1月至2017年11月于本院行腹腔镜胆囊切除术的80例患者，按随机原则分为4组：帕瑞昔布钠组、右美托咪定组、帕瑞昔布钠联合右美托咪定组及对照组。收集所有患者的人口学及临床资料，记录手术前及术中不同时间点的心率(heart rate, HR)、平均动脉压(mean arterial pressure, MAP)、颈静脉血氧饱和度(jugular venous oxygen saturation, SjvO2)及颈静脉血氧分压(jugular venous oxygen pressure, PjvO2)水平；同时测定简易精神状态检查表(mini-mental state examination, MMSE)评分、拉姆齐镇静评分(Ramsay score)与视觉模拟评分(Visual Analogue Score, VAS)。结果：帕瑞昔布钠组、右美托咪定组及联合组的SjvO2与PjvO2水平均显著高于对照组，且联合组两项指标均为各组最高。联合组的VAS评分显著低于其余三组，术后48h内患者自控静脉镇痛(patient controlled intravenous analgesia, PCIA)按压次数亦为各组最少。联合组的拉姆齐评分与MMSE评分均为各组最高，对照组则为最低。结论：帕瑞昔布钠联合右美托咪定可减轻老年患者腹腔镜胆囊切除术后的疼痛症状，改善术后镇静状态与认知功能。