汪海钢　王伟东　徐丽丽

[摘要] 目的 探讨分析氟比洛芬酯术中预注对老年髋关节置换术术后血浆S-100B蛋白、NSE浓度及认知功能的影响。 方法 随机选取我院在2015年2月～2017年2月期间收治的60例老年髋关节置换术患者为研究对象，并将其分为观察组和对照组，对照组患者采用异丙酚静脉全身麻醉，观察组患者采用氟比洛芬酯联合异丙酚静脉全身麻醉，对比观察两组患者血浆S-100B蛋白、NSE浓度及MMSE评分的变化情况。 结果 术前，两组患者血浆S-100B蛋白、NSE浓度比较差异无统计学意义（P>0.05）；术后，观察组患者血浆S-100B蛋白（1.89±0.46）ng/L、NSE浓度（20.16±6.31）ng/L，均显著优于对照组（P<0.05）；两组患者麻醉前后的HR并无明显变化，但麻醉后的SBP与DBP比较，差异有统计学意义（P<0.05）；两组患者术前的MMSE评分比较，差异无统计学意义（P>0.05）；术后12 h、24 h，观察组患者的MMSE评分明显高于对照组，两组比较差异有统计学意义（P<0.05）。 结论 氟比洛芬酯术中镇痛对老年髋关节置换术患者认知功能的影响较小，可显著降低患者术后的血浆S-100B蛋白、NSE浓度，具有积极的临床应用价值。

[关键词] 髋关节置换术；氟比洛芬酯；镇痛；认知功能

[中图分类号] R614 [文獻标识码] B [文章编号] 1673-9701（2017）24-0104-04

[Abstract] Objective To investigate the effect of intraoperative perfusion of flurbiprofen axetil on postoperative plasma S-100B protein， NSE concentration and cognitive function in elderly patients undergoing hip replacement. Methods A total of 60 elderly patients undergoing hip replacement who were admitted to our hospital from February 2015 to February 2017 were randomly selected as the research subjects. The patients were divided into observation group and control group. The patients in the control group were given intravenous general anesthesia with propofol， and the patients in the observation group were given intravenous general anesthesia with flurbiprofen axetil combined with propofol. The changes of plasma S-100B protein， NSE concentration and MMSE score were observed and compared between the two groups. Results There was no significant difference in plasma S-100B protein and NSE concentration between the two groups before the Surgery（P>0.05）. The levels of plasma S-100B protein（1.89±0.46） ng/L and NSE concentration （20.16±6.31） ng/L in the observation group were significantly higher than those in the control group after the surgery（P<0.05）. There was no significant change in HR between the two groups before and after anesthesia， but there was significant difference in SBP and DBP after anesthesia（P<0.05）； there was no statistically significant difference in MMSE scores between the two groups before the surgery（P>0.05）. The MMSE score in the observation group was significantly higher than that in the control group at 12 h and 24 h after the surgery（P<0.05）. There was significant difference between the two groups（P<0.05）. Conclusion The intraoperative analgesic effect of flurbiprofen axetil on the cognitive function of elderly patients undergoing hip replacement is less， which can significantly reduce the plasma S-100B protein and NSE concentration after the surgery， and has a positive clinical application value.endprint

[Key words] Hip replacement； Flurbiprofen axetil； Analgesia； Cognitive function

髋关节置换术多适用于中老年群体，但是由于中老年患者身体抵抗力与免疫力差，这在一定程度上增加了手术治疗的风险性[1-2]。术中麻醉方式对手术治疗效果及术后并发症发生风险具有直接影响。神经元特异性烯醇化酶（NSE）、S-100β 蛋白分别属于神经元的标志酶、神经胶质细胞的标志蛋白，很多相关医学研究已经报道了血浆中NSE、S-100β 蛋白变化可作为中枢神经系统损伤的标志物[3-4]，本组研究中通过检测氟比洛芬酯术中预注患者血浆中NSE、S-100B蛋白的变化情况，进一步探讨氟比洛芬酯麻醉对患者认知功能的影响，现报道如下。

1 资料与方法

1.1 一般资料

选择2015年2月～2017年2月在我院行髋关节置换术的老年患者60例作为研究对象，并将患者随机分为观察组与对照组，每组各为30例。观察……