麻醉深度控制对老年乳腺癌患者术后认知功能及高迁移率族蛋白B1水平的影响分析  

Effects of anesthesia depth control on cognitive function and high mobility group protein B-1 level in older adult patients with breast cancer

作　　者：任晓燕[1] 姜艳华[1] 郭丽丽[1] 陈杰[1] 马虹[1] Ren Xiaoyan;Jiang Yanhua;Guo Lili;Chen Jie;Ma Hong(Department of Anesthesia,The First Hospital of China Medical University,Shenyang 110001,Liaoning Province,China)

机构地区：[1]中国医科大学附属第一医院麻醉科,沈阳110001

出　　处：《中国基层医药》2021年第6期824-829,共6页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的:探讨麻醉深度控制对老年乳腺癌患者术后认知障碍以及高迁移率族蛋白B1(HMGB-1)水平的影响。方法:选取中国医科大学附属第一医院2019年6月至2020年6月确诊为乳腺癌实施乳腺切除术的老年女性患者86例为观察对象,采用随机数字表法分为浅麻组和深麻组,每组43例。均采用苯巴比妥钠和阿托品进行干预,深麻组脑电双频指数(BIS)值在30~45之间;浅麻组BIS值在45~60之间,在手术时进行不同深度的麻醉,并对两组患者不同时间段的平均动脉压(MAP)和心率(HR)指标、高迁移率族蛋白(HMGB-1)水平、简易智能精神状态检查量表(MMES)评分进行评定与检测。结果:两组患者在各个时间段MAP水平差异均无统计学意义(均P>0.05);两组患者各个时间段HR差异均无统计学意义(均P>0.05);HMGB-1水平比较,麻醉诱导前(T0)和手术结束(T1)时间段,两组患者的HMGB-1水平差异无统计学意义(P>0.05),术后1 d(T2)和术后2 d(T3)时间段,深麻组的HMGB-1水平表达[(75.46±3.33)pg/mL、(93.98±4.32)pg/mL]均明显低于浅麻组[(87.89±5.13)pg/mL、(121.01±4.36)pg/mL],差异均有统计学意义(t=13.327、28.878,均P<0.05);术前1 d,两组MMSE评分差异无统计学意义(P>0.05),深麻组术后1 dMMES评分为(26.73±1.11)分,术后3 d评分为(28.16±0.72)分,术后6 d评分为(28.97±0.88)分,均明显高于浅麻组[(21.03±1.46)分、(22.39±1.24)分、(24.69±0.57)分],差异均有统计学意义(t=20.380、26.388、26.768,均P<0.05)。结论:在老年乳腺癌患者乳腺切除术中,采用深度麻醉方式有助于减轻术后认知功能障碍的发生,降低HMGB-1的表达,对患者术后康复起到积极的促进作用。Objective To investigate the effects of anesthesia depth control on cognitive function and high mobility group protein B1(HMGB-1)level in older adult patients with breast cancer.Methods Eighty-six female older adult patients with breast cancer who received mastectomy between June 2019 and June 2020 in the First Hospital of China Medical University,China were included in this study.They were randomly assigned to undergo anesthesia with sodium phenobarbital and atropine at deep(bispectral index 30-45,deep anesthesia group,n=43)or superficial level(bispectral index 45-60,superficial anesthesia group,n=43).The mean arterial pressure,heart rate,HMGB-1 level,Mini-Mental State Examination(MMSE)score were assessed in each group.Results There were no significant differences in mean arterial pressure and heart rate recorded during each time period between the deep anesthesia and superficial anesthesia groups(all P>0.05).No significant difference in HMGB-1 level was found between the two groups before anesthesia induction and at the end of surgery(both P>0.05).At 1 and 2 days after surgery,HMGB-1 level in the deep anesthesia group was(75.46±3.33)pg/mL and(93.98±4.32)pg/mL,respectively,which was significantly lower than that in the superficial anesthesia group[(87.89±5.13)pg/mL and(121.01±4.36)pg/mL,t=13.327,28.878,both P<0.05)].At 1 day before surgery,there was no significant difference in MMSE score between the two groups(P>0.05).In the deep anesthesia group,MMSE score was(26.73±1.11)points,(28.16±0.72)points,and(28.97±0.88)points at 1,3 and 6 days after surgery respectively,which was significantly higher than that in the superficial anesthesia group[(21.03±1.46)points,(22.39±1.24)points,and(24.69±0.57)points,t=20.380,26.388,26.768,all P<0.05].Conclusion Deep anesthesia for mastectomy in older adult patients can reduce cognitive impairment and decrease HMGB-1 level after surgery,and plays a positive role in postoperative recovery.

关 键 词：麻醉 全身 乳腺肿瘤 乳房切除术 手术后并发症 认知障碍 高迁移率族蛋白质类 心率 血压 治疗结果 

分 类 号：R737.9[医药卫生—肿瘤] R614[医药卫生—临床医学]