ABSTRACT
Objective:To evaluate the effects of celecoxib on postoperative cognitive function in elderly patients with hip fracture.Methods:One hundred and thirty patients with hip fracture patients from July 2017 to July 2019 in Shanghai Songjiang Fangta Hospital of Traditional Chinese Medicine were selected. All patients were treated with the same anesthetic and surgical methods. The patients were divided into celecoxib group (66 patients) and control group (64 patients) by random number table method. The patients in celecoxib group were given oral administration of celecoxib 200 mg 12 h before surgery and 12, 24, 48 h after surgery; the patients in control group were given oral administration of placebo at the same time. Patients were treated with sufentanil intravenous analgesia pump. The serum levels of C reactive protein (CRP), interleukin (IL)-6, tumor necrosis factor (TNF)-α and prostaglandin E 2 (PG-E 2) 12 h before surgery and 4, 24, 48 h after surgery were determined. The pain intensity 1, 4, 24 and 48 h after surgery was measured by visual analogue scale (VAS) score. Cognitive function before surgery and 7 d after surgery was assessed by mini-mental state examination (MMSE), and the MMSE 7 d after surgery <23 scores was diagnosed postoperative cognitive dysfunction (POCD). Results:There was no statistical difference in VAS score 1 and 4 h after surgery between 2 groups ( P>0.05); the VAS score 24 and 48 h in celecoxib group was significantly lower than that in control group: (4.3 ± 1.2) scores vs. (6.1 ± 1.6) scores and (4.0 ± 0.9) scores vs. (7.8 ± 1.3) scores, and there was statistical difference ( P<0.05). There were no statistical difference in CRP, IL-6, TNF-α and PG-E 2 12 h before surgery between 2 groups ( P>0.05); the CRP, IL-6, TNF-α and PG-E 2 4, 24 and 48 h after surgery in celecoxib group were significantly lower than those in control group, and there were statistical differences ( P<0.05). There was on statistical difference in MMSE before surgery between 2 groups ( P>0.05); MMSE 7 d after surgery in celecoxib group was significantly higher than that in control group: (25.1 ± 1.9) scores vs. (23.9 ± 1.5) scores, the incidence of POCD was significantly lower than that in control group: 10.6% (7/66) vs. 28.1% (18/64), and there were statistical differences ( P<0.05). Conclusions:Celecoxib can decrease early POCD incidence after hip fracture surgery in elderly patients, which might be mediated by suppressing inflammation and acute postoperative pain caused by surgical trauma.
ABSTRACT
Objective To study the application of dexmedetomidine in patients with combined spinal epidural anesthesia and its effects on hemodynamics and renin angiotensin aldosterone system (RAAS).Methods96 patients with open surgery under combined spinal epidural anesthesia from Oct.2013 to Oct.2016 in our hospital were selected.Divided into two groups by randomly, the dexmedetomidine group(46 cases) was given dexmedetomidine before anesthesia, the control group(46 cases) was given sodium chloride solution.The operation condition, and the changed of mean arterial pressure (MAP), heart rate, plasma renin activity (PRA), angiotensin II (ANG-II) and aldosterone (ALD) at before anesthesia (T1), post anesthesia 10min (T2), end of the operation (T3) and end of the operation 30 min (T4) were compared.ResultsThere was no significant difference in the operation time, blood loss, intraoperative transfusion, and wake up time between the two groups;there was no significant difference in MAP and heart rate between the two groups at T1, at T2, T3, T4 point, control group MAP, heart rate were significantly changed(P<0.05), and there was no significant change in dexmedetomidine group, at T2,T3,T4 point, the levels of MAP, heart rate in the dexmedetomidine group were lower than the control group(P<0.05);there was no significant difference between the two groups in PRA, ANG-Ⅱ and ALD at T1, at T2 and T3 point, the PRA, ANG-Ⅱ and ALD in the two groups were increased, at T4 point down, there were significant differences compared with the same group at T1(P<0.05);but at T2,T3,T4, the levels of PRA,ANG-Ⅱ,ALD were lower than the control group(P<0.05).ConclusionIn the combined spinal epidural anesthesia with dexmedetomidine before anesthesia, which can Maintain hemodynamic stability, And inhibit the activation of RAAS.