不同浓度氟比洛芬酯超前镇痛对行髋关节置换术老年患者认知功能及IL-6浓度的影响

doi:10.3969/j.issn.1006-6233.2021.11.04

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摘要 目的: 探究不同浓度氟比洛芬酯超前镇痛对行髋关节置换术老年患者认知功能及白介素-6(IL-6)浓度的影响。方法: 选取2018年3月至2021年3月我院行髋关节置换术老年患者108例,将患者简单随机分为两组,均54例。对照组予以1.0mg/kg氟比洛芬酯,静脉推注,研究组予以5.0mg/kg氟比洛芬酯,静脉推注。观察对比两组术前第1天、术后第1天、术后第3天的认知功能[简易精神状态量表(MMSE)]、术后2h、12h、24h、48h疼痛情况[视觉模拟量表(VAS)]、术前、术后即刻、术后24h IL-6水平及不良反应情况。结果: 两组一般资料比较上,两组在性别、年龄、BMI等一般资料上比较(P>0.05),具有可比性。两组不同时点认知功能MMSE评分比较上,重复测量方差分析显示,两组认知功能MMSE评分的时点间、组间差别及时点与组别的交互效应差异有统计学意义(P<0.05)。事后组内成对比较结果显示,两组患者术后1d两组认知功能MMSE评分相较于治疗前呈明显的下降趋势(P<0.05),两组患者术后3d两组认知功能MMSE评分相较于术后1d呈明显的上升趋势(P<0.05)。事后组间成对比较结果显示,术前1d,两组认知功能MMSE评分比较差异无统计学意义(P>0.05);术后1d、术后3d,研究组认知功能MMSE评分均高于对照组,差异有统计学意义(P<0.05)。两组不同时点VAS疼痛评分比较上,重复测量方差分析显示,两组VAS疼痛评分的时点间、组间差异有统计学意义(P<0.05),时点与组别的交互效应差异无统计学意义(P>0.05)。事后组内成对比较结果显示,两组患者术后12h相较于术后2hVAS疼痛评分呈明显的上升趋势,两组术后24h、48h相较于术后12hVAS疼痛评分呈明显的下降趋势(P<0.05)。事后组间成对比较结果显示,术后2h、术后12h、术后24h、术后48h,研究组VAS疼痛评分均低于对照组,差异有统计学意义(P<0.05)。两组不同时点IL-6水平比较上,重复测量方差分析显示,两组IL-6水平的时点间、组间差别差异有统计学意义(P<0.05),时点与组别的交互效应差异无统计学意义(P>0.05)。事后组内成对比较结果显示,两组患者术后即刻、术后24h两组IL-6水平相较于术前呈明显的上升趋势(P<0.05)。事后组间成对比较结果显示,术前,两组IL-6水平比较差异无统计学意义(P>0.05);术后即刻、术后24h,研究组IL-6水平均低于对照组,差异有统计学意义(P<0.05)。安全性评价上,研究组发生恶心反应2例(3.70%),对照组发生皮疹1例(1.85%),两组不良反应比较,差异无统计学意义(χ²=3.343,P=0.558>0.05)。结论: 对行髋关节置换术老年患者予以5.0mg/kg氟比洛芬酯超前镇痛,有利于改善患者认知功能,减轻患者手术疼痛,降低炎症因子水平,且安全可靠。

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关键词 ：髋关节置换术, 氟比洛芬酯, 超前镇痛, 认知功能, 白介素-6

Abstract：Objective: To explore the effect of different concentrations of flurbiprofen axetil on the cognitive function and the concentration of interleukin-6 (IL-6) in elderly patients undergoing hip arthroplasty. Methods: A total of 108 elderly patients undergoing hip arthroplasty in our hospital from March 2018 to March 2021 were selected and simply randomly divided into two groups, with 54 cases in each. The control group received 1.0 mg/kg flurbiprofen axetil as an intravenous bolus, and the study group received 5.0 mg/kg flurbiprofen axetil as an intravenous bolus. The cognitive function [Mini Mental State Scale (MMSE)], pain at 2h, 12h, 24h, 48h after operation (visual simulation Scale (VAS)], IL-6 levels and adverse reactions before operation, immediately after operation, and 24 hours after operation were observed and compared. Results: The two groups were compared in general data such as gender, age, and BMI (P>0.05). The cognitive function MMSE scores of the two groups was compared at different time points. Repeated measures analysis of variance showed that the differences in the time points of the cognitive function MMSE scores between the two groups and the interaction effects between the time points and the groups were statistically significant (P<0.05). The results of the pairwise comparison within the groups afterwards showed that the cognitive function MMSE scores of the two groups of patients 1d after the operation showed a significant downward trend compared with those before the treatment (P<0.05), and the cognitive function MMSE of the two groups of patients 3d after the operation showed a significant upward trend compared with 1 day after operation (P<0.05). The results of the paired comparison between the groups afterwards showed that there was no significant difference in the cognitive function MMSE scores between the two groups on the 1st day before the operation (P>0.05); the cognitive function MMSE scores of the study group were higher than those of the study group 1d after operation and 3d after operation. In the control group, the difference was statistically significant (P<0.05). The VAS pain scores between the two groups were compared at different time points. Repeated measures analysis of variance showed that there were statistically significant differences in the VAS pain scores between the two groups at time points and between groups (P<0.05), and there was no difference in the interaction effects between time points and groups. The difference was tatistically significant (P>0.05). The results of the pairwise comparison within the group showed that the VAS pain scores of the two groups showed a significant upward trend at 12h after surgery compared with 2h after surgery, and the VAS pain scores of the two groups showed a significant downward trend at 24h and 48h after surgery compared to 12h after surgery ( P<0.05). The results of the paired comparison between the groups afterwards showed that the VAS pain scores of the study group were lower than those of the control group at 2h, 12h, 24h, and 48h after the operation, and the difference was statistically significant (P<0.05). The IL-6 levels of the two groups at different time points. Repeated measures analysis of variance showed that the differences in IL-6 levels between the two groups were statistically significant (P<0.05), and the interaction between time points and groups was not statistically significant (P>0.05). The results of a pairwise comparison within the group after the event showed that the IL-6 levels of the two groups immediately after the operation and 24 hours after the operation showed a significant upward trend compared with the pre-operation (P<0.05). The results of the paired comparison between the groups afterwards showed that there was no significant difference in the levels of IL-6 between the two groups before the operation (P>0.05); immediately after the operation and 24 hours after the operation, the IL-6 levels of the study group were lower than those of the control group. The difference was statistically significant (P<0.05). In terms of safety evaluation, 2 cases (3.70%) had nausea in the study group and 1 case (1.85%) had a rash in the control group. There was no significant difference in adverse reactions between the two groups (χ²=3.343, P=0.558>0.05). Conclusion: Preemptive analgesia for elderly patients undergoing hip replacement surgery with 5.0 mg/kg flurbiprofen axetil is beneficial to improving the cognitive function of the patients, which can reduce the surgical pain of the patients, reduce the level of inflammatory factors, and is safe and reliable.

Key words： Hip replacement Flurbiprofen axetil Preemptive analgesia Cognitive function Interleukin-6

基金资助:山西省自然科学基金项目,(编号:2018011039)

引用本文:

武志平, 安晓刚, 孔雅俊. 不同浓度氟比洛芬酯超前镇痛对行髋关节置换术老年患者认知功能及IL-6浓度的影响[J]. 河北医学, 2021, 27(11): 1777-1782.
WU Zhiping, AN Xiaogang, KONG Yajun. Effect of Preemptive Analgesia with Different Concentrations of Flurbiprofen Axetil on Cognitive Function and IL-6 Concentration in Elderly Patients Undergoing Hip Arthroplasty. HeBei Med, 2021, 27(11): 1777-1782.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2021.11.04 或 http://www.hbyxzzs.cn/CN/Y2021/V27/I11/1777

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