Wang Jin-Huo, Liu Tong, Bai Yu, Chen Yong-Quan, Cui Ying-Hui, Gao Xin-Yue, Guo Jian-Rong
Department of Anesthesiology and Perioperative Medicine, Gongli Hospital, Naval Military Medical University, Shanghai, China.
Department of Anesthesiology, The First Affiliated Hospital of Wannan Medical College, Wuhu, China.
Front Pharmacol. 2023 Mar 20;14:947982. doi: 10.3389/fphar.2023.947982. eCollection 2023.
This study aimed to clarify the effect of parecoxib sodium on the occurrence of postoperative delirium and to investigate its possible mechanism. A total of 80 patients who underwent elective hip arthroplasty in our hospital between December 2020 and December 2021 were selected and randomly divided into two groups: a parecoxib sodium group (group P, = 40) and a control group (group C, = 40). Patients in group P were intravenously injected with 40 mg of parecoxib sodium 30 min before anesthesia and at the end of the surgery. Patients in group C were intravenously injected with the same volume of normal saline at the same time points. The primary endpoint was the incidence of POD, and the secondary endpoints were the levels of inflammatory factors (tumor necrosis factor- α [TNF-α], interleukin [IL]-1β, IL-6, and IL-10), nerve injury-related factors (brain-derived neurotrophic factor [BDNF], S-100β protein, neuron-specific enolase [NSE], and neurofilament light chain [NfL]), and antioxidant factors (heme oxygenase-1 [HO-1]), as well as the Visual Analogue Scale (VAS) and Confusion Assessment Method-Chinese Reversion (CAM-CR) scores. The incidence of POD was 10% in group P and 27.5% in group C. Intergroup comparison revealed that the levels of TNF-α, IL-1β, S-100β, NfL, and NSE were lower, and BDNF was higher, in group P than in group C at each postoperative time point. The levels of IL-6 were lower, and the levels of IL-10 and HO-1 were higher, in group P than in group C at 1 h and 1 day postoperatively ( < 0.05). Three days after surgery, the differences in the levels of IL-6, IL-10, and HO-1 were not statistically significant between the two groups ( > 0.05). The VAS and CAM-CR scores were lower at each postoperative time point in group P than in group C ( < 0.05). Parecoxib sodium could reduce postoperative pain, decrease the plasma levels of inflammatory and nerve injury-related factors, upregulate HO-1 levels, and reduce the incidence of POD. The results of this study suggest that parecoxib sodium may reduce the occurrence of POD through the effects of anti-inflammation, analgesia, and antioxidants.
本研究旨在阐明帕瑞昔布钠对术后谵妄发生的影响，并探讨其可能的机制。选取2020年12月至2021年12月在我院接受择期髋关节置换术的80例患者，随机分为两组：帕瑞昔布钠组（P组，n = 40）和对照组（C组，n = 40）。P组患者在麻醉前30分钟及手术结束时静脉注射40mg帕瑞昔布钠。C组患者在相同时间点静脉注射相同体积的生理盐水。主要终点是术后谵妄（POD）的发生率，次要终点是炎症因子（肿瘤坏死因子-α [TNF-α]、白细胞介素 [IL]-1β、IL-6和IL-10）、神经损伤相关因子（脑源性神经营养因子 [BDNF]、S-100β蛋白、神经元特异性烯醇化酶 [NSE]和神经丝轻链 [NfL]）、抗氧化因子（血红素加氧酶-1 [HO-1]）的水平，以及视觉模拟评分（VAS）和中文版谵妄评估方法（CAM-CR）评分。P组POD的发生率为10%，C组为27.5%。组间比较显示，术后各时间点P组TNF-α、IL-1β、S-100β、NfL和NSE的水平均低于C组，而BDNF水平高于C组。术后1小时和1天时，P组IL-6水平低于C组，IL-10和HO-1水平高于C组（P < 0.05）。术后3天，两组IL-6、IL-10和HO-1水平的差异无统计学意义（P > 0.05）。术后各时间点P组的VAS和CAM-CR评分均低于C组（P < 0.05）。帕瑞昔布钠可减轻术后疼痛，降低炎症和神经损伤相关因子血浆水平，上调HO-1水平，并降低POD的发生率。本研究结果表明，帕瑞昔布钠可能通过抗炎、镇痛和抗氧化作用降低POD的发生。
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