Objective To investigate the effect of flurbiprofen acetate on postoperative cognitive dyssfunction (POCD) and inflammatory factors after laparoscopy surgery in elderly patients. Methods Eighty patients undergoing laparoscopic cholecystectomy, were randomly divided into flurbiprofen acetate groups (group F, n=40) and control groups (group C, n=40). Before induction of general anesthesia, group F received intravenous injection of flurbiprofen 50 mg, and re-injected 50 mg 12 h after surgery. Group C received an equal volume of fat emulsion and re-injected an equal volume of fat emulsion 12 h after surgery. The visual analogue scale (VAS) was used for pain scores at 0, 6, 12, 24, 48, and 72 h after surgery.Neuropsychological testing was performed with mini-mental state examination (MMSE)on the preoperative day,1th and 3th postoperative day. The development of POCD was recorded within 3 days after surgery. Venous blood samples were taken before induction (to), immediately after surgery (t1), 12 hours after surgery (t2), and 24 hours after surgery (t3). Serum levels of interleukin-6(IL-6) and tumor necrosis factor-α (TNF-α) were measured by enzyme-linked immunosorbent assay (ELISA). Results Compared with group C, the resting VAS score decreased from 0 to 48 h after operation in group F (P<0.05). The MMSE scores of 48 hours before or after operation of the group C were (28.4±1.4) and (23.2±1.6), respectively, and that of group F were (28.6±1.4) and (26.0±1.8) , respectively; the postoperative score of the group F was significantly higher than that of the group C (P<0.05); The incidence of POCD in group C was 28% within 72 hours after operation, but 15% in group F, which was significantly lower than that in group C (P<0.05). Compared with group C, the serum concentrations of IL-6(29.3±6.2,32.8±8.0,30.7±7.1) ng·L-1were significantly decreased in group F(F<0.05).Compared with group C,the serum concentrations of TNF-α were (13.0±3.1,14.5±4.4) ng·L-1 at t1- t2 were significantly decreased in group F(P<0.05). Conclusion Flurbiprofen acetate can reduce the occurrence of cognitive dysfunction in elderly patients undergoing laparoscopic cholecystectomy,and its mechanism may be related to pain relief and inhibition of inflammatory response.
STEINMETZ J,SIERSMA V,KESSING L V,et al.Is post-operative cognitive dysfunction a risk factor for dementia? A cohort follow-up study[J].Br J Anaesth,2013,110(1) :92-97.
BARR J,FRASER G L,PUNTILLO K,et al.Clinical prac-tice guidelines for the management of pain,agitation,and delirium in adult patients in the intensive care unit[J].Crit Care Med,2013,41(1):263-306.
RATNALIKAR V,WILLIAMS C,MOSES T.Perioperative pain management in colorectal surgery[J].Intestinal Surgery,2017,35:8.
YANG Y G,HU L H,CHEN H,et al.Targetcontrolled infu-sion of remifentanil with or without flurbiprofen axetil in sedation for extracorporeal shock wave lithotripsy of pancreatic stones:a prospective,open-label,randomized controlled trial[J].BMC Anesthesiol,2015,15:161.
PENG L,XU L,OUYANG W.Role of peripheral inflam-matory markers in postoperative cognitive dysfunction:a meta-analysis[J].PLoS One,2013,8(11):e79624.