七氟醚吸入麻醉对老年食道癌患者认知功能的影响  

Influrence of Sevoflurane Inhalation Anesthesia on Cognitive Function of Older Patients with Esophageal Cancer

作　　者：王威 崔崇英 辛开荣 田家齐[3] 李金矿 李家凤[4] 夏中元[1] Wang Wei;Cui Chongying;Xin Kairong;Tian Jiaqi;Li Jinkuang;Li Jiafeng;Xia Zhongyuan(Department of Anesthesiology,the People's Hospital of Wuhan University,Wuhan 430061,China;Department of Ultrasound Imaging,Zhongxiang People's Hospital of Hubei Province,Zhongxiang 431900,China;Department of Cardiovascular Medicine,Zhongxiang People's Hospital of Hubei Province,Zhongxiang 431900,China;Department of Psychiatry,Zhongxiang People's Hospital of Hubei Province,Zhongxiang 431900,China)

机构地区：[1]武汉大学人民医院麻醉科,武汉430061 [2]湖北省钟祥市人民医院超声影像科,钟祥431900 [3]湖北省钟祥市人民医院心血管内科,钟祥431900 [4]湖北省钟祥市人民医院精神医学科,钟祥431900

出　　处：《国际老年医学杂志》2020年第3期150-153,共4页International Journal of Geriatrics

基　　金：湖北省卫生和计划生育委员会项目(WJ2017F097);荆门市引导性科研计划项目(YDKY 2017056)。

摘　　要：目的探究七氟醚吸入麻醉对老年食道癌患者认知功能的影响。方法将64例老年食道癌行手术治疗的患者纳入研究,随机数值法分为吸入麻醉组(术中七氟醚吸入麻醉)和静脉麻醉组(术中异丙酚静脉靶控麻醉)。对比两组手术中不同时间心率和平均动脉压;对比两组患者睁眼时间、应答时间、拔管时间;对比两组术前、术后1 d、术后7 d白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)、S-100β浓度;对比两组术前、术后1 d、术后7 d蒙特利尔认知量表(MoCA)评分和简易精神状态检查量表(MMSE)评分。结果两组术中心率、平均动脉压比较差异无统计学意义(P>0.05);吸入麻醉组睁眼时间、应答时间、拔管时间均较静脉麻醉组长(P<0.001);术后1 d、7 d吸入麻醉组IL-6、TNF-α、S-100β水平均较静脉麻醉组高(P<0.05);术后1 d、7 d吸入麻醉组MoCA、MMSE评分均较静脉麻醉组低(P<0.05)。结论吸入麻醉患者麻醉恢复较静脉麻醉慢,两种麻醉方法均对患者术后早期认知功能有影响,但吸入麻醉的影响更大,七氟醚吸入麻醉用于老年食道癌患者手术治疗中引起的术后认知功能降低可能与S-100β蛋白浓度和炎症反应有关。Objective To analyze the influence of sevoflurane inhalation anesthesia on cognitive function in older patients with esophageal cancer.Methods 64 older patients with esophageal cancer were randomly divided into the group anesthetized with sevoflurane inhalation anesthesia and the group anesthetized with propofol intravenous anesthesia.The heart rate,mean arterial pressure(MAP),the time of eye opening,response and extubation of patients were documented.The levels of interleukin-6(IL-6),tumor necrosis factor alpha(TNF-а)and S-100βin plasma were tested before,at 1 d and 7 d after surgery.Montreal cognitive scale(MoCA)and mini mental state examination scale(MMSE)were assessed before,at 1 d and 7 d after surgery.Results There were no significant differences on the heart rate and MAP between the two groups(P>0.05).The time of eye opening,response and extubation of patients in the inhalation anesthesia group were longer than those in the intravenous anesthesia group(P<0.001).The levels of IL-6,TNF-αand S-100βin the inhalation anesthesia group were higher than those in the intravenous anesthesia group at 1 d and 7 d after surgery(P<0.05).The scores of MoCA and MMSE in the inhalation anesthesia group were lower than those in the intravenous anesthesia group at 1 d and 7 d after sursery(P<0.05).Conclusion The recovery of patients undergoing inhalation anesthesia is more slowly than those undergoing intravenous anesthesia.Both anesthesia methods may reduce the early cognitive function of patients after surgery,but the effect of inhalation anesthesia is more significant.Decreased early postoperative cognitive function caused by sevoflurane inhalation anesthesia may be related to S-100βprotein concentration and inflammatory response in elderly patients with esophageal cancer.

关 键 词：食道癌 七氟醚 异丙酚 麻醉 认知功能 

分 类 号：R614[医药卫生—麻醉学] R735.1[医药卫生—外科学]