氟比洛芬酯超前镇痛对老年患者行腹腔镜下胆总管探查术后认知功能及炎性反应的影响
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摘要
目的氟比洛芬酯超前镇痛对老年患者行腹腔镜下胆总管探查术(LCBDE)后认知功能及炎性反应的影响。方法选取68例老年胆总管结石患者,分为观察组和对照组各34例。观察组予以氟比洛芬酯超前镇痛,对照组予以术后常规镇痛。比较两组患者术后视觉模拟评分(VAS)、简易精神状态量表(MMSE)评分和炎性指标的变化。结果观察组术后2 h、6 h、12 h、24 h、48 h的VAS评分及术后48 h镇痛药物使用例数和平均次数均明显低于对照组(t分别=14.82、16.61、11.03、14.83、15.49,=4.53,t=10.16,P均<0.05)。两组患者术后7 d MMSE评分的差异无统计学意义(t=1.38,P>0.05),但是观察组术后1 d和3 d的MMSE评分明显高于对照组,且术后7 d内认知功能障碍(POCD)发生率也低于对照组(t分别=2.64、2.01,χ~2=5.31,P均<0.05)。观察组术后6 h、12 h、24 h、48 h的血清肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6)水平均明显低于对照组,差异均有统计学意义(t分别=8.10、9.24、6.18、5.27、8.59、7.88、6.43、10.28,P均<0.05)。结论氟比洛芬酯可以减轻老年患者LCBDE术后疼痛和炎症反应,降低POCD的发生率。
Objective To explore the effect of preemptive analgesia with flurbiprofenaxetil on cognitive function and in-flammatory response in elderly patients after laparoscopic common bile duct exploration(LCBDE). Methods Totally 68 elderly patients with choledocholithiasis were divided into observation group(34 cases)treated with flurbiprofenaxetil pre-emptive analgesia and control group(34 cases)treated with postoperative conventional analgesia.The scores of visual ana-logue scale(VAS),mini-mental state examination(MMSE)and inflammatory parameters were compared between thetwo groups. Results The VAS score at 2 h,6 h,12 h,24 h and 48 h after operation,and the total number of cases andthe average number of analgesic drugs used within 48 h after operation in the observation group were significantly lower than those in the control group(t=14.82,16.61,11.03,14.83,15.49,χ~2=4.53,t=10.16,P<0.05).There was no significant difference in the MMSE score between the two groups on 7 th day after operation(t=1.38,P>0.05),but theMMSE scores of the observation group were significantly higher than those in the control group on 1 st and 3 rd days afteroperation,and the incidence of postoperative cognitive dysfunction(POCD)within 7 days after operation was also lower than that in the control group(t=2.64,2.01,χ~2=5.31,P<0.05).The levels of serum tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)in the observation group were significantly lower than those in the control group at 6 h,12 h,24 h and 48 h after operation(t=8.10,9.24,6.18,5.27,8.59,7.88,6.43,10.28,P<0.05). Conclusion Flurbiprof-enaxetil can reduce pain and inflammatory reaction in elderly patients after LCBDE,and decrease the incidence of POCD.
Objective To explore the effect of preemptive analgesia with flurbiprofenaxetil on cognitive function and in-flammatory response in elderly patients after laparoscopic common bile duct exploration(LCBDE). Methods Totally 68 elderly patients with choledocholithiasis were divided into observation group(34 cases)treated with flurbiprofenaxetil pre-emptive analgesia and control group(34 cases)treated with postoperative conventional analgesia.The scores of visual ana-logue scale(VAS),mini-mental state examination(MMSE)and inflammatory parameters were compared between thetwo groups. Results The VAS score at 2 h,6 h,12 h,24 h and 48 h after operation,and the total number of cases andthe average number of analgesic drugs used within 48 h after operation in the observation group were significantly lower than those in the control group(t=14.82,16.61,11.03,14.83,15.49,χ~2=4.53,t=10.16,P<0.05).There was no significant difference in the MMSE score between the two groups on 7 th day after operation(t=1.38,P>0.05),but theMMSE scores of the observation group were significantly higher than those in the control group on 1 st and 3 rd days afteroperation,and the incidence of postoperative cognitive dysfunction(POCD)within 7 days after operation was also lower than that in the control group(t=2.64,2.01,χ~2=5.31,P<0.05).The levels of serum tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)in the observation group were significantly lower than those in the control group at 6 h,12 h,24 h and 48 h after operation(t=8.10,9.24,6.18,5.27,8.59,7.88,6.43,10.28,P<0.05). Conclusion Flurbiprof-enaxetil can reduce pain and inflammatory reaction in elderly patients after LCBDE,and decrease the incidence of POCD.
引文
1董涛.术后认知功能障碍发病机制的研究进展[J].中国微创外科杂志,2014,14(15):113-117.
2于璐,马鸿雁,石景辉.术后认知功能障碍的影响因素[J].医学综述,2018,24(9):1781-1784,1789.
3张婧,陈岩,容俊芳.术后认知功能障碍影响因素的研究进展[J].中华老年多器官疾病杂志,2017,16(2):113-116.
4张倩,尤浩军.“超前镇痛”研究进展及麻醉中应用[J].中国疼痛医学杂志,2016,22(4):241-244.
5王松平,荚卫东,李建生.超前镇痛在术后镇痛中的应用进展[J].实用肝脏病杂志,2014,17(4):433-436.
6周小炫.中文版简易智能精神状态检查量表在脑卒中患者中的信效度初步研究[D].福州:福建中医药大学,2015.
7王迎虎.氟比洛芬酯的药理及临床应用进展[J].天津药学,2018,30(2):58-71.
8姚志文,赵振龙,古妙宁.氟比洛芬酯用于腹腔镜胆囊切除术超前镇痛的Meta分析[J].中国疼痛医学杂志,2012,18(12):729-734.
9陈燕勤,邱灿金.氟比洛芬酯超前镇痛在胸腰椎后路融合术术后镇痛中的应用[J].浙江实用医学,2018,23(1):29-31.
10熊世义,刘敬臣.氟比洛芬酯注射液超前镇痛的临床应用[J].医学综述,2010,16(3):444-446.
11颜萍,王德明.老年人术后认知功能障碍危险因素的研究与防治进展[J].实用心脑肺血管病杂志,2012,20(5):917-919.
12吴亦影,卞雷斯,宁敏,等.炎症反应在脑动脉微栓子导致的大脑神经元损伤机制中的作用[J].中国临床神经科学,2011,19(1):16-22.
13李英,计超,潘在兴.脓毒症患者血清PCT、hs-CRP及IL-6表达水平及其临床意义[J].海南医学,2018,29(2):212-214.
14蔡栋臣,柳旦,徐卫红.降钙素原和肿瘤坏死因子对评估急性胰腺炎的病情严重程度和预后预测的临床价值[J].中国卫生检验杂志,2018,28(11):1390-1391,1394.
15 Li YC,Xi CH,An YF,et al.Perioperative inflammatory response and protein S-100βconcentrations-relationship with post-operative cognitive dysfunction in elderly patients[J].Acta Anaesthesiol Scand,2012,56(5):595-600.
2于璐,马鸿雁,石景辉.术后认知功能障碍的影响因素[J].医学综述,2018,24(9):1781-1784,1789.
3张婧,陈岩,容俊芳.术后认知功能障碍影响因素的研究进展[J].中华老年多器官疾病杂志,2017,16(2):113-116.
4张倩,尤浩军.“超前镇痛”研究进展及麻醉中应用[J].中国疼痛医学杂志,2016,22(4):241-244.
5王松平,荚卫东,李建生.超前镇痛在术后镇痛中的应用进展[J].实用肝脏病杂志,2014,17(4):433-436.
6周小炫.中文版简易智能精神状态检查量表在脑卒中患者中的信效度初步研究[D].福州:福建中医药大学,2015.
7王迎虎.氟比洛芬酯的药理及临床应用进展[J].天津药学,2018,30(2):58-71.
8姚志文,赵振龙,古妙宁.氟比洛芬酯用于腹腔镜胆囊切除术超前镇痛的Meta分析[J].中国疼痛医学杂志,2012,18(12):729-734.
9陈燕勤,邱灿金.氟比洛芬酯超前镇痛在胸腰椎后路融合术术后镇痛中的应用[J].浙江实用医学,2018,23(1):29-31.
10熊世义,刘敬臣.氟比洛芬酯注射液超前镇痛的临床应用[J].医学综述,2010,16(3):444-446.
11颜萍,王德明.老年人术后认知功能障碍危险因素的研究与防治进展[J].实用心脑肺血管病杂志,2012,20(5):917-919.
12吴亦影,卞雷斯,宁敏,等.炎症反应在脑动脉微栓子导致的大脑神经元损伤机制中的作用[J].中国临床神经科学,2011,19(1):16-22.
13李英,计超,潘在兴.脓毒症患者血清PCT、hs-CRP及IL-6表达水平及其临床意义[J].海南医学,2018,29(2):212-214.
14蔡栋臣,柳旦,徐卫红.降钙素原和肿瘤坏死因子对评估急性胰腺炎的病情严重程度和预后预测的临床价值[J].中国卫生检验杂志,2018,28(11):1390-1391,1394.
15 Li YC,Xi CH,An YF,et al.Perioperative inflammatory response and protein S-100βconcentrations-relationship with post-operative cognitive dysfunction in elderly patients[J].Acta Anaesthesiol Scand,2012,56(5):595-600.