丙泊酚靶控输注联合七氟烷吸入维持麻醉对老年非小细胞肺癌患者术后血清神经元特异性烯醇化酶和β-淀粉样蛋白水平及认知功能的影响  

Effect of target-controlled infusion propofol combined with inhalation sevoflurane to maintain anesthesia on the postoperative changes of serum neuron specific enolase,β-amyloid protein and cognitive function in elderly patients with non-small cell lung cancer

作　　者：贺康 张新新 查德 沈强[1] He Kang;Zhang Xinxin;Zha De;Shen Qiang(Department of Anesthesiology,Jinhua City′s Hospital of Traditional Chinese Medicine Affiliated to Zhejiang University of Traditional Chinese Medicine,Jinhua Hospital of Traditional Chinese Medicine of Zhejiang Province,Zhejiang Jinhua 321000,China)

机构地区：[1]浙江中医药大学附属金华中医医院浙江省金华市中医医院麻醉科,321000

出　　处：《中国医师进修杂志》2021年第9期810-814,共5页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨丙泊酚靶控输注联合七氟烷吸入维持麻醉对老年非小细胞肺癌(NSCLC)患者术后血清β-淀粉样蛋白(β-AP)、神经元特异性烯醇化酶(NSE)水平及认知功能的影响。方法回顾性分析浙江省金华市中医医院2017年12月至2019年12月78例行胸腔镜手术治疗的老年NSCLC患者的临床资料。其中,麻醉维持采用丙泊酚靶控输注39例(对照组),麻醉维持采用丙泊酚靶控输注联合七氟烷吸入39例(研究组)。比较两组手术前后血清β-AP和NSE水平、认知功能[采用简易智能状态检查量表(MMSE)评估]、术后恢复情况(睁眼时间、应答时间和拔管时间)及不良反应发生率。结果两组术前β-AP和NSE比较差异无统计学意义(P>0.05);研究组术后即刻和术后6 hβ-AP和NSE明显低于对照组[β-AP:(416.13±22.81)μg/L比(510.73±24.27)μg/L和(373.53±21.72)μg/L比(430.68±22.15)μg/L,NSE:(8.35±0.66)μg/L比(11.13±0.73)μg/L和(7.81±0.61)μg/L比(9.12±0.68)μg/L],差异有统计学意义(P<0.01);两组术后24 hβ-AP和NSE比较差异无统计学意义(P>0.05)。两组术前MMSE评分比较差异无统计学意义(P>0.05);研究组术后6、24和72 h MMSE评分明显高于对照组[(22.32±2.05)分比(20.54±2.31)分、(25.19±1.33)分比(23.61±1.08)分和(26.84±0.97)分比(25.01±1.15)分],差异有统计学意义(P<0.01);两组术后7 d MMSE评分比较差异无统计学意义(P>0.05)。研究组睁眼时间、应答时间和拔管时间均明显短于对照组[(14.15±3.20)min比(19.32±3.14)min、(18.08±3.52)min比(24.63±4.10)min和(16.21±4.40)min比(22.31±4.71)min],差异有统计学意义(P<0.01)。两组总不良反应发生率比较差异无统计学意义(P>0.05)。结论老年NSCLC患者术中采取丙泊酚靶控输注联合七氟烷吸入维持麻醉,可减小血清β-AP和NSE水平升高幅度,减轻对认知功能的损害,术后恢复较快,且不会增加不良反应发生率,安全性较高。Objective To investigate the effect of target-controlled infusion propofol combined with inhalation sevoflurane to maintain anesthesia on the postoperative changes of serumβ-amyloid protein(β-AP),neuron specific enolase(NSE)and cognitive function in elderly patients with non-small cell lung cancer(NSCLC).Methods The clinical data of 78 elderly patients with NSCLC who underwent thoracoscopic surgery from December 2017 to December 2019 in Jinhua Hospital of Traditional Chinese Medicine of Zhejiang Province were retrospectively analyzed.Among them,target-controlled infusion propofol to maintain anesthesia was in 39 cases(control group),and target-controlled infusion propofol combined with inhalation sevoflurane to maintain anesthesia was in 39 cases(study group).The serum levelsβ-AP,NSE and cognitive function(assessed by mini mental state examination,MMSE)before and after operation,the postoperative recovery(eye opening time,response time and extubation time)and incidence of adverse reactions were compared between 2 groups.Results There were no statistical differences inβ-AP and NSE before operation between 2 groups(P>0.05);theβ-AP and NSE immediately and 6 h after operation in study group were significantly lower than those in control group,β-AP:(416.13±22.81)μg/L vs.(510.73±24.27)μg/L and(373.53±21.72)μg/L vs.(430.68±22.15)μg/L,NSE:(8.35±0.66)μg/L vs.(11.13±0.73)μg/L and(7.81±0.61)μg/L vs.(9.12±0.68)μg/L,and there were statistical differences(P<0.01);there were no statistical differences inβ-AP and NSE 24 h after operation between 2 groups(P>0.05).There was no statistical difference in MMSE score before operation between 2 groups(P>0.05);the MMSE score 6,24 and 72 h after operation in study group was significantly higher than that in control group:(22.32±2.05)scores vs.(20.54±2.31)scores,(25.19±1.33)scores vs.(23.61±1.08)scores and(26.84±0.97)scores vs.(25.01±1.15)scores,and there was statistical difference(P<0.01);there was no statistical difference in MMSE score 7 d after operation b

关 键 词：癌 非小细胞肺 二异丙酚 磷酸丙酮酸水合酶 淀粉样蛋白 认知功能 七氟烷 

分 类 号：R614[医药卫生—麻醉学] R734.2[医药卫生—外科学]