地氟醚对老年结直肠癌患者术后认知功能障碍的影响  

Effects of desflurane anaesthesia on postoperative cognitive dysfunction in elderly patients undergoing colorectal cancer surgery

作　　者：黄硕 王子申[3] HUANG Shuo;WANG Zi-shen(Shandong First Medical University&Shandong Academy of Medical Sciences,Taian 271016,China;Dept. of Anesthesiology, The Fifth Hospital of Xiamen Xiamen,361101,China;Dept of Anesthesiology, Affiliated Hospital of Taishan Medical College Tai an, 271000, China)

机构地区：[1]山东第一医科大学(山东省医科院),山东泰安271016 [2]厦门市第五医院麻醉科,福建厦门361101 [3]泰山医学院附属医院,山东泰安271000

出　　处：《泰山医学院学报》2019年第6期413-416,共4页Journal of Taishan Medical College

摘　　要：目的探讨地氟醚对老年结直肠癌手术患者术后认知功能障碍的影响。方法选取我院2015年1月至2018年10月收治的50例老年结直肠癌手术患者作为研究对象,随机将患者分为对照组和观察组,每组25例。对照组患者采用丙泊酚静脉麻醉,观察组采用地氟醚吸入麻醉。比较两组患者术后的呼吸恢复时间、睁眼时间、吞咽反射恢复时间、拔除气管导管时间,并于术前1d(T0)、术后1d(T1)、3d(T2)、7d(T3)应用简易智能精神状态检查表(MMSE)评估两组患者认知功能,于T0、术后30min(T4)、6h(T5)、12h(T6)取患者静脉血应用ELISA法测定血清中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。结果术后,观察组的睁眼时间、呼吸恢复时间、吞咽反射恢复时间、拔除气管导管时间较对照组均明显缩短(P<0.05);与T0比较,两组患者T1、T2的MMSE评分均明显降低(P<0.05),但观察组仍较对照组高(P<0.05);与T0比较,两组T4~T6时S100β蛋白、NSE含量及IL-1β、IL-6、TNF-α表达量均明显升高(P<0.05),但与对照组比较,观察组T4、T5时S100β蛋白、IL-1β、IL-6及NSE明显降低,T4~T6时TNF-α明显降低(P<0.05)。结论地氟醚吸入麻醉可有效减少老年结直肠癌患者术后3d内认知功能障碍的发生。长期POCD的发生尚需进一步深入研究。Objective:Objective The goal of this study was to investigate the effect of desflurane on postoperative cognitive dysfunction in elderly patients undergoing colorectal cancer surgury. Methods A total of 50 elderly patients with colorectal cancer who were admitted to our hospital from January 2015 to October 2018 were randomly divided into a control group and an observation group with 25 patients in each group. The patients in control group received propofol intravenous anesthesia and the patients in observation group received desflurane inhalation anesthesia. Compare two groups of patients with postoperative respiratory recovery time, opening eyes time, swallowing reflex recovery time, pulling out the endotracheal tube time, and mini-mental state examination (MMSE) score was applied to assess cognitive function of patients in two groups in preoperative 1 d (T0), postoperative 1 d (T1), 3 d (T2), 7 d (T3) respectively, The venous blood of patients in T0, 30 min (T4), 6 h (T5), 12 h (T6) after surgery were extracted. ELISA method was applied to assess the expression levels of S-100 beta protein, neuron specific enolase (NSE), IL-1beta, IL-6 and TNF-alpha. Results The duration of eye opening, respiratory recovery, deglutition reflex recovery and removal of tracheal catheter after operation in the observation group were significant shorter than those in the control group (P<0.05).Compared with T0, MMSE scores of T1 and T2 in both groups were reduced significantly (P<0.05), but MMSE scores in the observation group was still higher than those in the control group (P<0.05).Compared with T0, both groups showed increased significantly expression of S-100 beta protein, NSE content, IL-1beta, IL-6 and TNF-alpha at T4 ~ T6 (P<0.05). However, compared with the control group, S-100 beta protein, IL-1beta, IL-6 and NSE in the observation group were decreased significantly at T4 and T5, and TNF-alpha in the observation group was decreased significantly at T4 ~ T6 (P<0.05). Conclusion desflurane inhaled anesthesia can reduce effe

关 键 词：老年 结直肠癌 地氟醚 丙泊酚 全身麻醉 认知功能 

分 类 号：R614[医药卫生—麻醉学]