全麻下高龄患者腹腔镜胃癌根治术血VEGF变化对术后POCD发生的影响  

Impacts of blood VEGF changes on postoperative POCD in elderly patients undergoing laparoscopic radical gastrectomy under general anesthesia

作　　者：王传光[1] 周建伟[1] 高丽娟[1] 徐宏涛[1] 郑芳 吴振华[1] 吴建平[1] 丁海阳[1] WANG Chuanguang;ZHOU Jianwei;GAO Lijuan;XU Hongtao;ZHENG Fang;WU Zhenhua;WU Jianping;DING Haiyang(Department of Anesthesiology,Lishui Municipal Central Hospital,Lishui 323000,China)

机构地区：[1]丽水市中心医院麻醉科,浙江丽水323000

出　　处：《中国现代医生》2021年第16期130-133,共4页China Modern Doctor

基　　金：浙江省卫生健康科技计划项目(2021KY413);浙江省丽水市高层次人才培养资助项目(2019RC03)。

摘　　要：目的探讨全麻腹腔镜胃癌根治术患者血管内皮生长因子(VEGF)监测结果与术后认识功能障碍(POCD)发生的影响及临床意义。方法选择2019年1—12月丽水市中心医院实施腹腔镜胃癌根治术,年龄≥65岁的患者80例。连续监测并记录术中各项生命体征,分别于气管插管前15 min(T1),术后2 h(T2),术后24 h(T3)3个时间点采用简易智能精神状态量表(MMSE)对患者进行评分,并在这3个时间点内同步检测患者血清的VEGF值。将T2的MMSE评分与T1时评分差值≥2分的患者列为观察组(n=40);将差值<2分患者列为对照组(n=40)。结果观察组患者一般情况及术中生命体征监测结果与对照组比较,差异无统计学意义(P>0.05)。在T1、T3时间点,观察组VEGF值与MMSE评分与对照组比较,差异无统计学意义(P>0.05)。T2时间点,观察组VEGF值为(467.7±79.8)pg/mL,高于对照组VEGF值(433.9±67.0)pg/mL,差异有统计学意义(P<0.05)。T2时间点,观察组MMSE评分(23.3±1.5)分,低于对照组MMSE评分(26.0±1.3)分,差异有统计学意义(P<0.05)。结论全麻腹腔镜胃癌根治术可使高龄患者在术后短期(2 h)内血清中VEGF显著增高,且VEGF的变化与POCD发生具有较大的相关性。Objective To investigate the impacts and clinical significance of vascular endothelial growth factor(VEGF)monitoring results and postoperative cognitive dysfunction(POCD)in patients undergoing laparoscopic radical gastrectomy under general anesthesia.Methods A total of 80 patients with age≥65 years old undergoing laparoscopic radical gastrectomy in Lishui Municipal Central Hospital from January to December 2019 were selected.The various vital signs during the operation were continuously monitored and recorded.The patients were scored with mini-mental state examination(MMSE)at 15 min before tracheal intubation(T1),2 hours after operation(T2)and 24 hours after operation(T3).Meanwhile,the serum VEGF levels of patients were synchronously detected at these three time points.The patients whose MMSE score of T2 was different from T1 by≥2 points were classified as the observation group(n=40),while those with difference<2 points were classified as the control group(n=40).Results There were no statistically significant differences between the observation group and the control group in general condition and intraoperative vital signs monitoring of patients(P>0.05).At T1 and T3 time points,there were no statistically significant differences in VEGF value and MMSE score between the observation group and the control group(P>0.05).At T2 time point,the VEGF value of the observation group was(467.7±79.8)pg/mL,higher than(433.9±67.0)pg/mL of the control group,with statistically significant difference(P<0.05).At T2 time point,the MMSE score of the observation group was(23.3±1.5)points,lower than(26.0±1.3)points of the control group,with statistically significant difference(P<0.05).Conclusion Laparoscopic radical gastrectomy for gastric cancer under general anesthesia can significantly increase serum VEGF in elderly patients within 2 hours after operation,and the change of VEGF is closely related to the occurrence of POCD.

关 键 词：腹腔镜 胃癌 全麻 血管内皮生长因子 术后认识功能障碍 

分 类 号：R735.2[医药卫生—肿瘤]