Effect and safety of dexmedetomidine and parecoxib sodium alone or in double combinations in improving restlessness in recovery period in patients undergoing thoracic surgery / 新乡医学院学报

ABSTRACT

Objective To explore the effect and safety of dexmedetomidine and parecoxib sodium alone or in double combinations in improving restlessness in recovery period in patients undergoing thoracic surgery.Methods One hundred and twenty eight patients who underwent thoracic surgery in the Central Hospital of Xinyang from September 2014 to September 2016 were selected and randomly divided into control group,dexmedetomidine group,parecoxib sodium group and combined group,with 32 cases in each group.Patients in the dexmedetomidine group were given 10 mL of saline at 0.5 h before surgery,and were given a slow injection of 0.5 μg · kg-1 of dexmedetomidine by intravenous injection at 10 minutes before the end of the operation.Patients in the parecoxib group were given 40 mg (10 mL) of parecoxib sodium 0.5 h by intravenous injection before surgery.Patients in the combined group were given 40 mg (10 mL) of parecoxib sodium 0.5 h by intravenous injection before surgery,and were given a slow injection of 0.5 μg · kg-1 of dexmedetomidine intravenously at 10 minutes before the end of the operation.Patients in the control group received intravenous injections of equal saline at 0.5 h before surgery and 10 minutes before the end of the operation.The operation time,peroperative bleeding,peroperative infusion volume,and anesthesia time were observed.Plasma tumor necrosis factor-α (TNF-t),C reactive protein (CRP) and interleukin-10 (IL-10) levels and TNF-α/IL-10 of all patients at the time of 10 min before induction of anesthesia (T0),15 min before extubation (T1),tracheal extubation time (T2),15 min after extubation (T3) were detected.At the same time,restlessness in stage of analepsia and sedation of all patients were evaluated.The adverse reactions of the four groups in the recovery stage were statistically analyzed.Results There was no significant difference in the operation time,peroperative bleeding,peroperative infusion volume and anesthesia time among the four groups(P ＞ 0.05).The levels of TNF-α,CRP and IL-10 at T1,T2 and T3 in the four groups were significantly higher than those at T0 (P ＜ 0.05).The levels of TNF-α,CRP,IL-10 at T2 and T3 were higher than those at T1 (P ＜0.05),but the levels of them at T3 were lower than those at T2 in the four groups(P ＜0.05).The TNF-α/IL-10 at T1,T2 and T3 in the control group was significantly higher than that at T0 (P ＜ 0.05),and TNF-α/IL-10 at T1,T2 and T3 in the other three groups was significantly lower than that at T0 (P ＜ 0.05).The level of TNF-α/IL-10 at T2 and T3 was higher than that at T1,at T3 it was higher than that at T2 in the control group(P ＜ 0.05) . But there was no significant difference among the time point of T1,T2 and T3 in the other three groups(P ＞ 0.05).Compared with the control group,TNF-α,CRP and TNF-α/IL-10 levels at T1,T2 and T3 in the other three groups were significantly lower(P ＜ 0.05),and IL-10 levels were significantly higher(P ＜0.05).The levels of TNF-α,CRP and TNF-α/IL-10 at T1,T2 and T3 in the combined group were significantly lower than those in dexmedetomidine group and parecoxib sodium group(P ＜ 0.05),while the IL-10 levels were significantly higher(P ＜ 0.05).The restlessness rate in the dexmedetomidine group,parecoxib sodium group and combined group were significantly lower than that in the control group (P ＜ 0.05),while the ramsay sedation was significantly higher (P ＜ 0.05).The restlessness rate in combined group was significantly lower than that in dexmedetomidine group and parecoxib sodium group (P ＜ 0.05).All the patients had no tachycardia,nausea,vomiting,respiratory depression and other adverse reactions.Conclusion Dexmedetomidine combined with parecoxib can reduce the restlessness rate significantly,and can produce some inhibition to the inflammatory reaction.The clinical effect of dexmedetomidine combined with parecoxib is better than dexmedetomidine and parecoxib sodium alone.