关键词: 氟比洛芬酯, 术后认知功能障碍, 炎症因子, 股骨头置换术, 高龄患者

Abstract:

Objective To observe the effect of flurbiprofen axetil on cognitive function and inflammatory factors in elderly patients with femoral head replacement. Methods Seventy-five aged patients selectively undergoing femoral head replacement under combined spinal-epidural anesthesia(CSEA) were randomly selected and divided into three groups according to random number table, and each group had 25 patients: group C (control group, normal saline was administrated in clinical patients), group S (solvent group, the lipo microspheres for Kaifen preparations were administrated in clinical patients), group K (Kaifen group, Kaifen Flurbiprofen axetil injection was administrated in clinical patients). The hemodynamic indexes: heart rate (HR), mean arterial pressure(MAP) in three groups were recorded respectively at time points of the 24th hour before surgery (T0), the end of surgery (T₁) and 3 hours (T₂), 12 hours (T₃) and 24 hours (T₄) after surgery, and 3 ml peripheral blood was extracted and retained to detect the plasma levels of tumor necrosis factor(TNF)-α, interleukin(IL)-6 and IL-1β using the ELISA assay. Furthermore, the mini-mental status examination (MMSE) was performed at time points of T₀, T₂, T₃ and T₄ to evaluate the occurrence of postoperative cognitive dysfunction (POCD) in all patients. Results Compared to group C and S, there were no significant differences in TNF-α, IL-6 and IL-1β levels in patients of group K between time points of T0 and T1; Compared to group C and S, there were no significant differences in MMSE in patients of group K between time points of T₀ and T₂; Compared to group C and S, the plasma levels of TNF-α, IL-6 and IL-1β in patients of group K were significantly decreased between time points of T₂ and T₄; Compared to group C and S, the MMSE score in patients of group K was significantly increased between time points of T₃ and T₄; Compared to group C and S, there were no significant differences in occurrences of nausea and vomiting and respiratory depression in patients of group K between time points of T₂ and T₄, and the pain score in group K were significantly lower than those in group C and S (P<0.05). In addition, the postoperative incidence rate of POCD in group K was significantly lower than those in group C and S. Conclusion The advanced use of flurbiprofen can reduce the perioperative inflammatory response and decrease the incidence rate and extent of POCD, but can not increase the incidence rate of complications such as postoperative nausea, vomiting and respiratory depression.

Key words: Flurbiprofen, Postoperative cognitive dysfunction, Inflammatory factor, Femoral head replacement, Aged patient