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.
引文
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