右美托咪定联合帕瑞昔布钠对老年腹腔镜胃癌手术患者应激反应、细胞免疫功能和认知功能的影响

摘要 目的：探讨帕瑞昔布钠和右美托咪定联合麻醉对老年腹腔镜胃癌手术患者细胞免疫功能、应激反应和认知功能的影响。方法：纳入2019年8月~2022年7月期间西安交通大学第二附属医院收治的150例老年腹腔镜胃癌手术患者。按照随机数字表法将患者分为帕瑞昔布钠组（n=50，帕瑞昔布钠）、右美托咪定组（n=50，右美托咪定）和联合组（n=50，右美托咪定联合帕瑞昔布钠）。对比三组临床指标、视觉模拟评分法（VAS）、简易精神状态检查表（MMSE）评分、术后认知功能障碍（POCD）发生率、应激反应指标[皮质醇（Cor）、肾上腺素（E）、促肾上腺皮质激素（ACTH）]、细胞免疫功能变化情况。结果：联合组的术后住院天数、肛门排气时间短于右美托咪定组、帕瑞昔布钠组（P<0.05）。联合组术后12 h、术后24 h、术后48 h VAS评分低于右美托咪定组、帕瑞昔布钠组（P<0.05）。联合组术后24 h、术后72 h MMSE评分高于右美托咪定组、帕瑞昔布钠组（P<0.05）。联合组的POCD发生率低于右美托咪定组、帕瑞昔布钠组（P<0.05）。三组术后1 d Cor、E、ACTH升高，但联合组低于帕瑞昔布钠组、右美托咪定组同期（P<0.05）。三组术后1 d CD8⁺升高，但联合组低于帕瑞昔布钠组、右美托咪定组同期；CD3⁺、CD4⁺、CD4⁺CD8⁺下降，但联合组高于帕瑞昔布钠组、右美托咪定组同期（P<0.05）。结论：右美托咪定联合帕瑞昔布钠应用于老年腹腔镜胃癌手术患者，镇痛效果显著，可减轻机体的应激反应、免疫抑制及对认知功能的损害。

Effects of Dexmedetomidine Combined with Parecoxib Sodium on Stress Response, Cellular Immune Function and Cognitive Function in Elderly Patients Undergoing Laparoscopic Gastric Cancer Operation

ABSTRACT Objective: To investigate the effects of parecoxib sodium combined with dexmedetomidine anesthesia on cellular immune function, stress response and cognitive function in elderly patients undergoing laparoscopic gastric cancer surgery. Methods: 150 elderly patients undergoing laparoscopic gastric cancer operation who were admitted to the Second Affiliated Hospital of Xi''an Jiaotong University from August 2019 to July 2022 were included as study subjects. Patients were divided into parecoxib sodium group (n=50, parecoxib sodium), dexmedetomidine group (n=50, dexmedetomidine) and combined group (n=50, dexmedetomidine combined with parecoxib sodium) according to the random number table method. The clinical indexes, visual analogue scale (VAS), mini-mental state examination (MMSE) score, incidence of postoperation cognitive dysfunction (POCD), stress response indexes [cortisol (Cor), epinephrine (E), adrenocorticotropic hormone (ACTH)] and cellular immune function were compared among three groups. Results: The hospital stay postoperation and anal exhaust time in combined group were shorter than those in dexmedetomidine group and parecoxib sodium group (P<0.05). The VAS scores in combined group at 12 h postoperation, 24 h postoperation and 48 h postoperation were lower than those in dexmedetomidine group and parecoxib sodium group (P<0.05). The MMSE scores in combined group at 24 h postoperation and 72 h postoperation were higher than those in dexmedetomidine group and parecoxib sodium group (P<0.05). The incidence of POCD in combined group was lower than that in dexmedetomidine group and parecoxib sodium group (P<0.05). The levels of Cor, E and ACTH in three groups increased at 1 day postoperation, but those in combined group were lower than those in parecoxib sodium group and dexmedetomidine group at the same time (P<0.05). CD8⁺ increased on the first day postoperation in three groups, but combined group was lower than that of parecoxib sodium group and dexmedetomidine group at the same time. CD3⁺, CD4⁺, CD4⁺/CD8⁺ decreased, but combined group was higher than that of parecoxib sodium group and dexmedetomidine group (P<0.05). Conclusion: Dexmedetomidine combine with parecoxib sodium has a significant analgesic effect in elderly patients undergoing laparoscopic gastric cancer operation, which can reduce the stress response, immunosuppression and damage to cognitive function.