氟比洛芬联合腰方肌阻滞对老年患者全身麻醉肾切除术后神经认知功能及炎症反应的影响

Effects of flurbiprofen combined with quadratus lumborum block on postoperative neurocognitive function and inflammatory response in elderly patients with nephrectomy under general anesthesia

目的评价氟比洛芬复合腰方肌阻滞对老年患者肾切除术后神经认知功能及炎症反应的影响。方法选择择期行腹腔镜肾切除术的老年患者60例,随机分为Q组(腰方肌阻滞组)和FQ组(氟比洛芬联合腰方肌阻滞组),每组30例。麻醉诱导前30 min,2组患者均予以超声引导下手术侧前路腰方肌阻滞。FQ组患者术前10 min静脉注射氟比洛芬1 mg·kg^(-1),随后2组患者均予以全身麻醉。记录术中丙泊酚、瑞芬太尼用量,术后24 h镇痛泵有效按压次数,评估术后6、24、48 h疼痛视觉模拟量表(VAS)评分及Bruggrmann舒适度量表(BCS)评分。于术前1 d和术后1、7 d采用简易精神状态检查(MMSE)评估患者的神经认知情况,并记录术后7 d内患者术后神经认知障碍(PND)的发生率。检测术前1 h和术后30 min、24 h血高迁移率族蛋白B 1(HMGB1)、白细胞介素(IL)-6的水平。结果与Q组相比,FQ组术中瑞芬太尼用量显著减少(P<0.05),术后24 h镇痛泵有效按压次数显著减少(P<0.05)。术后6、24 h,FQ组VAS评分显著低于Q组(P<0.05),BCS评分显著高于Q组(P<0.05)。术后1、7 d,FQ组MMSE评分显著高于Q组(P<0.05);术后7 d内FQ组PND的发生率显著低于Q组(7%vs.27%,P<0.05)。术后30 min、24 h,FQ组HMGB1、IL-6水平均显著低于Q组(P<0.05)。2组术后不良反应发生率无显著差异(P>0.05)。结论氟比洛芬联合腰方肌阻滞可降低肾切除术老年患者PND的发生率,可能与术后早期完善的镇痛效果及炎症因子水平降低有关。

AIM To evaluate the effects of flurbiprofen combined with quadratus lumborum block(QLB)on postoperative neurocognitive function and inflammatory response in elderly patients undergoing nephrectomy.METHODS Sixty elderly patients undergoing laparoscopic nephrectomy were randomized into group Q(QLB group)and group FQ(flurbiprofen combined with QLB group),30 patients in each group.Ultrasound guided anterior QLB were performed in all patients on the surgical side.Patients in group FQ received flurbiprofen 1 mg·kg^(-1)iv 10 min before surgery.Then both groups received general anesthesia.The dosages of propofol and remifentanil during surgery and the effective number of analgesia pump presses were recorded.The scores of visual analogue scale(VAS)and Bruggrmann comfort scale(BCS)were evaluated at 6,24,48 h after surgery.The neurocognitive function was evaluated at 1 d before surgery and 1 d and 7 d after surgery using the mini-mental state examination(MMSE),and the incidence of postoperative neurocognitive disorder(PND)within 7 d after surgery was recorded.Venous blood was collected and the serum levels of high mobility group box protein 1(HMGB1)and interleukin 6(IL-6)were tested 1 h before surgery and 30 min and 24 h after the surgery.RESULTS Compared with group Q,the dosage of remifentanil was significantly reduced in group FQ(P<0.05),and the effective numbers of analgesia pump presses were reduced in group FQ(P<0.05).At 6,24 h after surgery,the VAS score was lower,and the BCS score was higher in group FQ than group Q(P<0.05).Compared with group Q,the MMSE score at 1,7 d after surgery was significantly higher in the group FQ(P<0.05),the incidence of PND within 7 d after surgery was lower in group FQ(P<0.05).The HMGB1 and IL-6 levels at 30 min,24 h after the surgery were significantly lower in group FQ than group Q(P<0.05).CONCLUSION Flurbiprofen combined with QLB can reduce the incidence of PND in elderly patients undergoing nephrectomy,which may be related to the perfect early postoperative analgesia and the decreased levels of inflammatory cytokines.