Please wait a minute...
医药导报  2019, Vol. 38 Issue (6): 735-738    DOI: 10.3870/j.issn.1004-0781.2019.06.010
  本期目录 | 过刊浏览 | 高级检索 |
氟比洛芬酯对老年患者腹腔镜胆囊术后认知功能及炎症因子的影响*
倪旭青(),汪炜健()
温州医科大学附属第一医院麻醉科,温州 325600
Effect of Flurbiprofen Acetate on Postoperative Cognitive and Inflammatory Factors After Laparoscopic Cholecystectomy in Elderly Patients
Xuqing NI(),Weijian WANG()
Department of Anesthesiology,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325600,China
全文: PDF(1176 KB)   HTML
输出: BibTeX | EndNote (RIS)      
摘要 

目的 探讨氟比洛芬酯对老年患者腹腔镜胆囊手术后认知功能障碍(POCD)及炎症因子的影响。方法 80例择期行腹腔镜胆囊切除术老年患者,采用随机数字表法分为氟比洛芬酯组和对照组,每组40例。全身麻醉诱导前,氟比洛芬酯组静脉注射氟比洛芬酯50 mg,术后12 h再次注射50 mg,对照组给予等容量脂肪乳剂,术后12 h再次注射等容量脂肪乳剂。分别于术毕即刻和术后6,12,24,48,72 h静息时采用视觉模拟评分(VAS)进行疼痛评分;分别于术前24 h、术后24 h和术后72 h采用简易智能状态量表(MMSE)进行患者认知功能评分,记录72 h内POCD的发生情况;分别于诱导前(to)、手术结束即刻(t1)、术后12 h(t2)、术后24 h(t3)抽取静脉血样,采用酶联免疫吸附测定(ELISA)检测血清中白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)的水平。结果 与对照组比较,氟比洛芬酯组术毕即刻到术后48 h静息VAS评分降低(P<0.05)。对照组术前24 h MMSE评分(28.4±1.4)分,术后24 h为(23.2±1.6)分,氟比洛芬酯组分别为(28.6±1.4)和(26.0±1.8)分,氟比洛芬酯组术后评分明显高于对照组(P<0.05); 对照组术后72 h内POCD发生率为28.0%,氟比洛芬酯组为15.0%,明显降低(P<0.05)。与对照组比较,t1-t3时点氟比洛芬酯组血清IL-6为(29.3±6.2),(32.8±8.0),(30.7±7.1) ng·L-1,浓度降低(P<0.05);t1、t2时点氟比洛芬酯组血清TNF-α为(13.0±3.1),(14.5±4.4) ng·L-1,浓度降低(P<0.05)。结论 氟比洛芬酯可减少老年患者腹腔胆囊术后认知功能障碍的发生,其机制可能与减轻患者疼痛以及抑制炎症反应有关。

服务
把本文推荐给朋友
加入引用管理器
E-mail Alert
RSS
作者相关文章
倪旭青
汪炜健
关键词 氟比洛芬酯认知功能疼痛评分炎症反应    
Abstract

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.

Key wordsFlurbiprofen acetate    Cognitive dysfuntion    Pain scores    Inflammatory
收稿日期: 2018-03-02      出版日期: 2019-06-11
基金资助:*温州市公益性社会发展科技项目(Y20160393)
引用本文:   
倪旭青,汪炜健. 氟比洛芬酯对老年患者腹腔镜胆囊术后认知功能及炎症因子的影响*[J]. 医药导报, 2019, 38(6): 735-738.
Xuqing NI,Weijian WANG. Effect of Flurbiprofen Acetate on Postoperative Cognitive and Inflammatory Factors After Laparoscopic Cholecystectomy in Elderly Patients. Herald of Medicine, 2019, 38(6): 735-738.
链接本文:  
http://www.yydbzz.com/CN/10.3870/j.issn.1004-0781.2019.06.010      或      http://www.yydbzz.com/CN/Y2019/V38/I6/735
组别 术毕即刻 6 h 12 h 24 h 48 h 72 h
对照组 3.6±1.0 3.8±0.8 4.6±0.9 3.6±0.7 2.6±0.6 1.3±0.5
氟比洛芬酯组 1.6±0.4 2.0±0.6 2.2±0.7 1.9±0.6 1.6±0.5 1.2±0.5
t 3.86 2.43 5.08 2.71 2.12 0.32
P <0.01 0.02 <0.01 0.01 0.04 0.78
表1  两组患者不同时点VAS评分比较
组别 术前24 h 术后24 h 术后72 h
对照组 28.4±1.4 23.2±1.6*1 27.2±2.0
氟比洛芬酯组 28.6±1.4 26.0±1.8*1*2 27.8±1.8
表2  两组患者不同时点MMSE评分比较
组别与时间 IL-6 TNF-α
对照组
t0 14.3±5.7 10.9±3.1
t1 65.0±9.2 18.9±4.5
t2 78.5±11.2 20.3±4.9
t3 63.8±7.3 13.1±4.1
氟比洛芬酯组
t0 14.5±5.5 11.0±3.2
t1 29.3±6.2*1 13.0±3.1*1
t2 32.8±8.0*1 14.5±4.4*1
t3 30.7±7.1*1 11.7±3.6
表3  两组患者不同时点血清IL-6和TNF-α浓度比较
[1] 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.
doi: 10.1093/bja/aes466
[2] 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.
doi: 10.1097/CCM.0b013e3182783b72
[3] RUNDSHAGEN I.Postoperative cognitive dysfunction[J].Dtsch Arztebl Int,2014,111(8):119-125.
[4] RATNALIKAR V,WILLIAMS C,MOSES T.Perioperative pain management in colorectal surgery[J].Intestinal Surgery,2017,35:8.
[5] 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.
doi: 10.1186/s12871-015-0141-6
[6] 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.
doi: 10.1371/journal.pone.0079624
[7] TERRANDO N,MONACO C,MA D,et al.Tumor necrosis factor-alpha triggers a cytokine cascade yielding postoperative cognitive decline[J].Proc Natl Acad Sci USA,2010,107(47):20518-20522.
doi: 10.1073/pnas.1014557107
[8] 唐霓,高云,俞虹,等.帕瑞昔布钠对老年抑郁大鼠手术后认知功能的影响[J].医药导报,2016,35(1):12-15.
doi: 10.3870/j.issn.1004-0781.2016.01.004
[9] KONG F J,MA L,ZHANG H H,et al.Alpha 7 nicotinic acetylcholine receptor agonist GTS-21 mitigates isoFlurane induced cognitive impairment in ages rats[J].J Aurg Res,2015,194(1):255-261.
[10] 李琼灿,方懿,刘绍明,等.氟比洛芬脂在预防老年全髋置换术后认知功能障碍的价值讨论[J].国际精神病学杂志,2015,42(5):94-97.
[1] 袁浩峥,王宁,许凤,杨毅猛,雷珊,张蓬勃. 小剂量地塞米松对乳腺区段切除术后患者免疫细胞的影响*[J]. 医药导报, 2019, 38(5): 595-599.
[2] 王承志,甘建辉,涂青,史金麟,于虹. 氢吗啡酮联合罗哌卡因对髋关节置换术患者术后认知功能的影响[J]. 医药导报, 2019, 38(5): 610-613.
[3] 许秋霞,那万秋,支胜利,王斓. 叶酸联合维生素B12治疗伴高同型半胱氨酸血症的轻度认知功能障碍50例[J]. 医药导报, 2018, 37(9): 1082-1085.
[4] 关天翔,秦秀德,林松俊,李晋芳,虢周科. 脑髓康对血管性痴呆模型大鼠认知功能的影响*[J]. 医药导报, 2018, 37(7): 809-812.
[5] 童华,李欣,王丽,段娜,孙志龙,李小刚. 氟比洛芬酯联合舒芬太尼用于经皮肾镜钬激光碎石术47例[J]. 医药导报, 2018, 37(4): 461-464.
[6] 王娟,田浩,谢敏杰,刘璐. 14,15-环氧化二十碳三烯酸对糖氧剥夺/复氧诱导的BV2细胞炎症反应的影响[J]. 医药导报, 2017, 36(8): 857-861.
[7] 曾佩佩,黎红丹,刘泰. 口服银杏叶提取物制剂治疗轻度认知功能障碍Meta分析*[J]. 医药导报, 2017, 36(7): 761-767.
[8] 陈玉华,余奇劲,陶红. 丙泊酚与七氟烷对老年患者非心脏手术后认知功能影响的Meta分析[J]. 医药导报, 2017, 36(5): 505-513.
[9] 占瑾琼,余斌,康光宇,闫琨,杨远坚. 7,8-二羟基黄酮对精神分裂症模型大鼠空间认知及海马突触结构的影响*[J]. 医药导报, 2017, 36(10): 1153-1157.
[10] 陈利娟,张庆松. 夜间大剂量丙戊酸钠治疗良性癫 伴中央颞区棘波患儿45例[J]. 医药导报, 2016, 35(9): 951-954.
[11] 陈镜楼,宋红萍. 渐尖毛蕨总黄酮抗前列腺增生的活性研究*[J]. 医药导报, 2016, 35(10): 1054-1058.
[12] 唐霓,高云,俞虹,白毅平. 帕瑞昔布钠对老年抑郁大鼠手术后认知功能的影响*[J]. 医药导报, 2016, 35(1): 12-15.
[13] 刘媛媛;万杏;刘敏;冷燕;夏中元. 盐酸右美托咪定对老年患者手术后早期认知功能的影响[J]. , 2015, 34(2): 214-217.
[14] 庾青,王剑,陈卉,邹桂香. 奥氮平联合无抽搐电休克治疗精神分裂症94例[J]. 医药导报, 2015, 34(10): 1298-1301.
[15] 杨鹏,侯俊,徐青果,陈春,汤和青,柯齐斌. 右美托咪定对脓毒症肺损伤大鼠的保护作用[J]. 医药导报, 2015, 34(1): 22-25.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   

通信地址:武汉市蔡甸区中法生态城同济医院专家社区C栋平层《医药导报》编辑部,邮政编码:430199
鄂ICP备07004419号
版权所有:《医药导报》编辑部
网址:www.yydb.cn;www.yydbzz.com
电话:027-69378382,69378383 电子邮箱: yydbzz@163.com
技术支持:北京玛格泰克科技发展有限公司 鄂ICP备09001709号-11