帕瑞昔布納预防性给药对老年创伤患者在重症 监护室术后谵妄发生的影响
l P^临床急诊急救\中国急救复苏与灾害医学杂志2020年7月第15卷第7期ChinJEmergResuscDisasterMed.July 2020,V〇1. 15N〇.7
谭公，黄巍峰素描照片素材
上海交通大学附属第六人民医院重症医学科，上海200030
什么的虾摘要：目的本研究目的在于评价帕瑞昔布钠的超前给药对老年创伤患者术后，在重症监护病房发生谵妄的影
响。方法在这项前瞻性、单中心、随机、双盲、安慰剂对照试验中，一共纳入了109名自2019年6—12月收治
于上海交通大学附属第六人民医院骨科并计划在术后进入重症监护病房的老年创伤患者。随机将符合标准的
患者分为安慰剂组(A组)和帕瑞昔布钠组(B组)，分别在术前给予生理盐水或帕瑞昔布钠40 nig。谵妄评估采
用意识模糊评估法中文修订版_主要观察指标为术后48h内谵妄的发生率，谵妄平均分和疼痛平均分。另外
研究期间监测入组患者不良事件的发生，包括消化道出血、心血管事件、伤口感染。结果在109例患者中，有
怎样写诗歌36例发生了术后谵妄(33%),13组的发生率明显低于A组(43.8% vs. 21.2%, P=0.015);B组的谵妄平均分和疼痛
平均分均小于A组(P<0.05)。两组患者术后均未发生严重的不良事件t结论术前预防性给予帕瑞昔布钠可
以有效降低老年骨科患者术后谵妄的发生率
关键词：术后谵妄；帕瑞昔布钠；创伤；预防性给药
满园春色中图分类号：R74文献标识码：A文章编号：丨673-6966(2020)07-0832-04
Effect of prophylactic administration of parecoxib sodium on postoperative delirium in elderly trauma patients in intensive care unit
T A N Qin, H U A N G Weifeng.Shanghai Jiao T o n g University Affiliated Sixth People's Hospital 200233, C h i n a组织结构图怎么做
Corresponding author: H U A N G Weifeng, E-mail: h r e e z e_h u a n g@s o h u.c o m
Abstract: Objective T o evaluate the effect of prophylactic administration of parecoxib s o d i u m o n postoperative deliri
u m of elderly orthopedic patients in the intensive care unit (ICU). Methods In this prospective, single-center, r a n d o mized, double-blind, placebo-controlled trial, a total of 109 elderly tr a u m a patients wer e included, from J u n e to D e c e m
ber 2019, admitted to o ur hospital a n d planned to enter the I C U postoperatively. Patients wer e r a n d o m L y divided into placebo group (group A) a n d parecoxib s o d i u m group (group B) with normal saline or parecoxib s o d i u m 40 m g given respectively before operation. T h e o u t c o m e s w ere the incidence of delirium within 48 hrs after operation, the average d e
lirium a n d average pain scores. During the study, inc idence of adver events wer e cloly monitored, including gastro- intestinal hemorrhage, cardiovascular events a n d w o u n d infection.
Results Finally, 36 of 109 patients developed P O D (33%), of w h i c h the incidence of group B w a s significantly lower than that of group A (43.8% vs. 21.2%, P=0.015). T h e average delirium scores a n d pain scores of group B were lower than that of group A(P<0.05). N o adver events o ccurred in the both two groups. Conclusion Prophylactic administration of parecoxib can effectively reduce the inci
d e n c e of postoperative delirium in elderly orthopedic patients.
熟练度Key words：Postoperative delirium; Parecoxib soudim; T r a u m a; Prophylactic administration物业管理机构
术后擔妄(postoperative delirium,POD)常见于术 后的老年患者，其主要临床特点包括认知减退，注意 力障碍以及可逆性的思维障碍等m。对于重症监护病 房(intensive care unit,ICU)接受机械通气的患者，PO D 的发生率可高达80%|M|。POD的出现往往会增加 ICU住院天数，严重影响了老年骨科患者术后关节功 能的恢复，提高了护理难度，增加了医疗保健支出，给 家庭和社会都带来巨大的经济负担|61。
临床上目前对于药物干预POD，最常见的是各类 抗精神病药物，而应用非甾体抗炎药(non-steroidal anti-inflammatory Drug,NSAID)进彳了干预的研究相对 较少m。在Cattabriga I等人纳入了 113例行择期心 脏手术患者的随机双盲对照试验中，NSAID的术后应 用显著减轻了患者术后疼痛，改善了患者
的谵妄状 态|81。但此类研究大多不是针对谵妄进行，仅将POD 作为次要结局指标进行观测，其证据效应均未达到理
努沙登加拉群岛基金项目：科技部数字诊疗重点专项(编号:2017Y F C0113800)；上海市综合医院中西医结合专项(编号:Z H Y Y-Z X Y J H Z X-2-2017010)；上海市浦江计划(编号：I8PJ1409200)
通信作者：黄巍峰，***************************
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