加速康复外科策略对肝切除术患者术后早期认知功能的影响  

Effects of enhanced recovery after surgery on early cognitive function of patients after hepatectomy for liver cancer

作　　者：黄松[1] 华福洲[1] 郎海丽[1] 杜晓红[1] 陈勇[1] 徐国海[1] 

机构地区：[1]南昌大学第二附属医院麻醉科,330006

出　　处：《临床麻醉学杂志》2016年第7期633-637,共5页Journal of Clinical Anesthesiology

基　　金：国家自然科学基金(81560193)

摘　　要：目的探讨加速康复外科（ERAS）策略对肝切除术患者术后早期认知功能的影响。方法筛选96例原发性肝癌择期行肝部分切除术患者,随机分为两组,每组48例。C组实施常规围术期处理及麻醉方法,ERAS组实施ERAS策略对围术期处理及麻醉方法进行优化。于术前1d（T0）、术后1d（T4）、3d（T5）、7d（T6）应用简易智能量表（MMSE）评估两组患者认知功能,于T0、术后30min（T1）、6h（T2）、12h（T3）、T4取患者静脉血检测血清S100β蛋白、神经元特异性烯醇化酶（NSE）含量和IL-1β、IL-6及TNF-α表达量。结果与C组比较,T4、T5时ERAS组MMSE评分明显升高,T1、T2时S100β蛋白、IL-1β、IL-6明显降低,T2、T3时NSE明显降低,T1-T3时TNF-α明显降低（P〈0.05）。与T0时比较,T4、T5时C组患者MMSE评分明显降低,T4时ERAS组MMSE评分明显降低（P〈0.05）。两组T1-T3时S100β蛋白明显升高,T2-T4时NSE含量明显升高,T1-T4时IL-1β、IL-6、TNF-α表达量均明显升高（P〈0.05）。结论 ERAS策略应用于肝癌肝切除术患者可改善患者术后认知功能,其机制可能与降低患者术后血清中S100β蛋白、NSE、IL-1β、IL-6及TNF-α的含量有关。Objective To investigate the effects of enhanced recovery after surgery（ERAS）pathway on early cognitive function of post-hepatectomy patients after hepatectomy.Methods Ninetysix patients undergoing elective hepatectomy for liver cancer were randomly assigned into two groups：group ERAS,n=48and group C,n=48.patients in group ERAS accepted perioperative and anaesthetic optimization of enhanced recovery after surgery pathway,and patients in group C received perioperative and anaesthetic management of normal surgery concept.The mini-mental state examination（MMSE）was used to test the cognitive function of the patients one day before operation（T0）,one day after operation（T4）,three days after operation（T5）and seven days after operation（T6）,and the blood levels of S100βprotein,neuron-specific enolase（NSE）,IL-1β,IL-6,and TNF-αwere detected at T0,30 minutes after operation（T1）,6hours after operation（T2）,12 hours after operation（T3）and T4.Results Compared with group C,MMSE scores in group ERAS were increased at T4,T5,the blood levels of S100βprotein,IL-1βand IL-6in group ERAS were decreased at T1,T2,the blood levels of NSE in group ERAS were decreased at T2,T3,the blood levels of TNF-αin group ERAS were decreased at T1-T3;Compared with the baseline value at T0,MMSE scores were decreased at T4,T5 in group C and decreased at T4 in group ERAS,the blood levels of S100βprotein in two groups were increased at T1-T3,the blood levels of NSE in two groups were increased at T2-T4,the blood levels of IL-1β,IL-6,and TNF-αin two groups were increased at T1-T4;and the postoperative length of stay in group ERAS were decreased.Conclusion Enhanced recovery after surgery pathway is helpful in improving early postoperative cognitive function of patients after hepatectomy,and the mechanism may be related to decreased the blood levels of S100βprotein,NSE,IL-1β,IL-6and TNF-α.

关 键 词：加速康复外科 肝切除术 术后认知功能 

分 类 号：R614[医药卫生—麻醉学]