不同麻醉方式对老年肺癌患者围术期认知功能及炎性因子的影响  

Effects of different anesthesia methods on cognitive function and inflammatory factors in elderly patients with lung cancer during perioperative period

作　　者：郭焱[1] 王泽华[1] 原志军[1] 任静 Guo Yan;Wang Zehua;Yuan Zhijun;Ren Jing(Department of Anesthesiology, Heji Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi 046000, China)

机构地区：[1]长治医学院附属和济医院麻醉科,046000

出　　处：《中国基层医药》2019年第8期979-983,共5页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探究不同麻醉方式对老年肺癌患者围术期认知功能及血清白细胞介素-6(IL-6).白细胞介素-8(IL-8)水平的影响。方法选择2015年3月至2017年3月长治医学院附属和济医院收治的行肺癌根治手术的老年患者90例作为研究对象,根据麻醉方式的不同分为吸入麻醉组(A组)、全身静脉麻醉组(B组)和硬脊膜外阻滞麻醉组(C组),每组30例:比较三组患者术前、术后1d和术后3 d的简明精神状态量表(MMSE)评分、认知功能障碍发生率以及血清IL-6.IL-8水平。结果术后1 d、3dC组MMSE评分分别为(25.62±2.11)分、(27.12±2.04)分,高于A组的(22.61±2.75)分、(25.78±2.68)分和B组的(22.34±2.01)分、(25.81±2.42)分,差异均有统计学意义(tA组=4.756、2.179,tB组=6.165,2.267,均P<0.05);术后1 d、3 d C组认知功能障碍发生率分别为26.67%(8/30)、6.67%(2/30),均低于A组的50.00%(15/30)、26.67%(8/30)和B组的66.67%(20/30)、30.00%(9/30),差异均有统计学意义(χ^2A组=3.455、4.320,χ^2B组=9.643>5.455,均P<0.05);术后1 d、3<1 C组患者血清IL-6和1L-8水平[IL-6:(99.53±16.82)ng/mL,(83.24±8.34)ng/mL,IL-8:(50.43±7.84)ng/mL,(42.15±5.25)ng/mL]均低于A组[IL-6:(122.43±18.41)ng/mL、(88.51±10.42)ng/mL,IL-8:(64.53±8.94)ng/mL,(55.62±6.78)ng/mL]和B组[IL-6:(124.52±20.10)ng/mL、(87.95±9.34)ng/mL,IL-8:(63.27±9.03)ng/mL,(54.62±6.30)ng/mL],差异均有统计学意义(IL-6:tA组=5.030,2.163,tB组=5.222,2.060,均P<0.05;tA组=6.495、8.604,tB组=5.881、8.329,均P<0.05)。结论使用硬脊膜外阻滞麻醉对老年肺癌根治术患者术后认知功能障碍的影响最小,能够抑制围术期患者炎性因子的表达,其效果优于其他两种麻醉方式,值得应用于老年肺癌根治手术。Objective To explore the effects of different anesthesia methods on cognitive function and serum interleukin -6( IL - 6 ), interleukin - 8 ( IL - 8 ) levels in elderly patients with lung cancer during perioperative period. Methods From March 2015 to March 2017 , ninety elderly patients undergoing radical resection of lung cancer treated in Heji Hospital Affiliated to Changzhi Medical College were selected in the research. According to the different anesthesia methods, they were divided into inhalation anesthesia group( A group), general intravenous anesthesia group( B group) and epidural block anesthesia group( C group), with 30 cases in each group. The minimum mental state exami nation ( MMSE) scores, cognitive dysfunction rate, serum IL - 6 and IL-8 levels of the three groups before operation,one day after operation and three days after operation were compared. Results One clay and three days after operation, the MMSE scores of C group were (25. 62 ± 2. 11 ) points,( 27. 12 ± 2. 04) points, respectively, which were higher than those of group A [( 22. 61 ± 2. 75 ) points,(25. 78 ± 2. 68 ) points] and B group [(22. 34 ± 2. 01 ) points,(25. 81 ± 2. 42 ) points ], the differences were statistically significant (tAgroup= 4. 756,2. 179 , tB group= 6. 165,2. 267,all P <0. 05). One day and three days after operation, the cognitive dysfunction rates of C group were 26. 67%( 8/30),6. 67%(2/30), respectively, which were lower than those of A group [ 50. 00%( 15/30),26. 67%(8/30)] and B group[ 66. 67%(20/30),30. 00%(9/30)], the differences were statistically significant ( χ^2Agroup= 3. 455 ,4. 320, χ^2Bgroup=9. 643 ,5. 455 , all P < 0. 05 ). One day and three days after operation, the serum IL-6 and IL-8 levels of C group [ IL - 6 :(99. 53 ± 16. 82) ng/ mL,( 83. 24 ± 8. 34) ng/ mL, IL - 8 :( 50. 43 ± 7. 84) ng/ mL,(42. 15 ±5. 25) ng/mL were lower than those of A group[ IL -6:(122.43 ± 18.41 ) ng/mL,(88. 51 ± 10. 42) ng/mL,IL-8:(64.53 ±8.94)ng/mL,(55.62 ± 6. 78 ) ng/mL] and B group [ IL - 6 :( 124. 52 ±20.

关 键 词：肺肿瘤 老年人 麻醉 吸入 麻醉 全身 麻醉 硬膜外 认知功能 炎性因子 

分 类 号：R614[医药卫生—麻醉学] R734.2[医药卫生—外科学]