氧化应激反应对老年患者炎症反应及术后认知功能障碍的影响  

Effect of oxidative stress on inflammatory response and postoperative cognitive dysfunction in aged patients

作　　者：李伟[1] 薛荣亮[1] 

机构地区：[1]西安交通大学医学院第二附属医院麻醉科,西安710004

出　　处：《山西医科大学学报》2011年第12期986-989,共4页Journal of Shanxi Medical University

基　　金：国家自然科学基金资助项目(81071071)

摘　　要：目的观察氧化应激反应对全身麻醉术后炎症反应及认知功能障碍(POCD)的影响。方法选择择期腹部手术行全身麻醉的患者60例,年龄60-75岁,随机分为2组:依达拉奉组(n=30)和对照组(生理盐水组,n=30),两组麻醉方法相同。依达拉奉组麻醉前静脉注射依达拉奉30 mg。对照组则于依达拉奉组相对应时间和途径注入相同容积的生理盐水。分别于麻醉后手术前(T1)、手术结束后即刻(T2)、手术结束后24 h(T3)抽取静脉血测定血浆IL-6含量及外周血中性粒细胞NF-κB表达水平。术前1或2 d以及术后第1,3,7天用《简易智能量表》测定认知功能,使用《简易精神测定表》评定术后谵妄。结果 14例患者出现认知功能障碍(23.33%),其中依达拉奉组4例,对照组10例;两组间差异有显著性(P<0.05)。两组T2、T3时点外周血中性粒细胞NF-κB表达均较T1增加(P<0.05),但依达拉奉组表达水平低于对照组(P<0.05)。两组T2时点血浆IL-6水平均较T1明显升高(P<0.01),且对照组血浆IL-6水平显著高于依达拉奉组(P<0.01);两组T3时点血浆IL-6水平较T2时点明显下降,但仍高于T1(P<0.05);T3时点两组间差异没有统计学意义(P>0.05)。依达拉奉组外周血中性粒细胞NF-κB表达水平与血浆IL-6有良好的相关性(r=0.69,P<0.01)。结论 POCD的发生与氧化应激反应有关,抑制NF-κB的激活可减少术后炎症反应及POCD的发生。Objective To investigate the effect of oxidative stress on inflammatory response and postoperative cognitive dysfunction（POCD）.Methods Sixty ASA Ⅰ-Ⅱ patients aged 60-75 years,undergoing the selective abdomen surgery with general anesthesia,were randomly assigned into 2 groups：edaravone group（n=30） and control group（n=30）.The patients were intravenously given edaravone（30 mg） in edaravone group and normal saline in control group before induction of anesthesia.Blood samples were taken from the central venous line to determine the plasma IL-6 level and NF-κB activation in neutrophils before induction of anesthesia（T1）,at the end of operation（T2）,24 h after operation（T3）.Neurocongnitive outcome was evaluated by mini-mental state examination（MMSE）and abbreviated mental test（AMT）at 1 d,2 d before operation and at 1 d,3 d,7 d after operation.Results Of 60 patients,14（23.33%） presented with POCD,including 4 patients in edaravone group and 10 patients in control group（P〈0.05）.Compared with T1,the plasma IL-6 level increased significantly at the end of operation（T2）and 24 h after operation（T3） in both groups（P〈0.05）.The level of IL-6 at T2 was significantly higher than that at T1 and T3 in both groups（P〈0.01）,and it is lower in edaravone group than in control group at T2（P〈0.01）.NF-κB in neutrophils was significantly higher at T2 and T3 than that at T1 in both groups（P〈0.05）,and it was lower in edaravone group than in control group（P〈0.05）.In edaravone group,NF-κB activation in neutrophils was positively correlated with plasma IL-6 level（r=0.69,P〈0.01）.Conclusion The incidence of POCD is correlated with oxidative stress.Inhibition of NF-κB activation may be helpful to attenuate inflammatory cytokines in aged patients undergoing abdomen surgery with general anesthesia and reduce the incidence of POCD.

关 键 词：NF-ΚB 氧化应激 依达拉奉 术后认知功能障碍 

分 类 号：R614.2[医药卫生—麻醉学]