Effects of non-steroidal anti-inflammatory drugs administered at different time points on mesenteric traction syndrome following open radical gastrectomy in elderly patients / 中华老年医学杂志

ABSTRACT

Objective:To investigate the effects of the non-steroidal anti-inflammatory drugs Parecoxib and Flurbiprofen administered at different time points on mesenteric traction syndrome(MTS).Methods:This was a prospective, randomized, controlled clinical trial.One hundred elderly patients scheduled for open radical gastrectomy under general anesthesia were randomly allocated to four groups the control group, the P-Pre-MT group, the F-Pre-MT group, and the F-Post-MT group(n=25, each group). Parecoxib 40 mg and Flurbiprofen 50 mg were intravenously administered 30 min and 5 min before skin incision in the P-Pre-MTS group and the F-Pre-MTS group, respectively.Flurbiprofen 50 mg was infused at the moment of MTS in the F-Post-MTS group while the control group was intravenously injected with saline.Anesthesia induction and maintenance were performed with plasma target-controlled infusion of Propofol and Remifentanil.After the incision of the peritoneum.The incidence of MTS, the duration of hypotension, and the use of norepinephrine during MTS were recorded.Systolic blood pressure(SBP), heart rate(HR), and effect-site concentration of Remifentanil were monitored at MT(T 0), 10 min(T 10), 20 min(T 20), 30 min(T 30), 45 min(T 45), and 60 min(T 60)after MT in patients with MTS. Results:MTS was observed in 19 of 22 patients(86%), 19 of 23 patients(83%), 0 of 24 patients(0%)and 20 of 23 patients(87%)in the control, P-Pre-MT, F-Pre-MT and F-Post-MT groups, respectively.The incidence of MTS in the F-Pre-MT group was lower than that in the control group( χ2=35.313, P=0.000). The duration of hypotension and the use of norepinephrine in patients with MTS were less in the F-Post-MT group than in the control group( P=0.007 and 0.015). SBP and HR at different time points after MT had significant differences in patients with MTS in the control group( F=47.425 and 26.318, P=0.000 and 0.000), but did not differ in the F-Pre-MT group( F=2.140 and 1.013, P=0.066 and 0.413). SBP and the effect-site concentration of Remifentanil were lower and HR was higher in the control group than in the F-Pre-MT group at T 10and T 20after MT( P=0.000), and SBP was higher and HR was lower in the F-Post-MT group than in the control group C at T 20after MT( P=0.002 and 0.002). Conclusions:Flurbiprofen not only can prevent the occurrence of MTS, maintain blood pressure stability and heart rate after MT, but also can reduce the duration of hypotension and the amplitude of heart rate increase when MTS occurs in elderly patients undergoing open radical gastrectomy.Parecoxib has no effect on MTS.