七氟烷预处理和右美托咪定对老年食管癌患者术后认知功能的影响  

Effects of sevoflurane preconditioning and dexmedetomidine on postoperative cognitive dysfunction in elderly patients with esophageal carcinoma

作　　者：崔松勤[1] 黄红芳[1] 黄雪莲[1] 芮骁 黄赛赛[1] CUI Song-qin;HUANG Hong-fang;HUANG Xue-lian;RUI Xiao;HUANG Sai-sai(Department of Anesthesiology,the Affiliated Hospital of Nantong University,Nantong 226000,China)

机构地区：[1]南通大学附属医院麻醉科,226000

出　　处：《天津医药》2021年第10期1089-1093,共5页Tianjin Medical Journal

摘　　要：目的比较七氟烷预处理和右美托咪定(DEX)对老年食管癌患者术后认知功能障碍(POCD)的影响,并探讨其可能机制。方法120例老年食管癌手术患者按随机数字表法分成对照组、七氟烷组、DEX组、DEX+七氟烷组,每组30例。麻醉诱导前,对照组只给予吸氧,七氟烷组给予七氟烷预处理,DEX组给予DEX预处理,DEX+七氟烷组给予七氟烷预处理的同时给予DEX预处理。测定4组入室后、插管后及拔管时的心率(HR)及平均动脉压(MAP),术后48 h视觉模拟评分法(VAS)评分及术后1、3、7 d的POCD发生率,检测入室后、拔管后及术后l、3、7 d血浆S100β蛋白和神经元特异性烯醇化酶(NSE)的水平。结果入室后、插管后及拔管时2种麻醉药物对HR、MAP的影响均无交互作用(P>0.05);与对照组比较,七氟烷组仅插管后HR降低,DEX组及DEX+七氟烷组插管后及拔管时HR、MAP均降低(P<0.05),七氟烷组术后48 h镇痛满意和疼痛明显患者比例差异均无统计学意义;与对照组、七氟烷组比较,DEX组和DEX+七氟烷组镇痛满意患者比例增加,而疼痛明显患者比例降低(P<0.05)。与对照组比较,七氟烷组术后1 d的POCD发生率降低,DEX组术后1、7 d的POCD发生率降低,DEX+七氟烷组术后1、3、7 d的POCD发生率均降低(P<0.05)。拔管后和术后1、3、7 d 2种麻醉药物对血清中S100β蛋白、NSE蛋白表达水平的影响无交互作用(P>0.05)。与对照组比较,七氟烷组拔管后和术后1、3 d血清中S100β蛋白、NSE蛋白表达水平降低(P<0.05);DEX组拔管后和术后1、3、7 d血清中S100β蛋白、NSE蛋白水平均降低(P<0.05)。结论七氟醚和DEX预处理均能抑制老年食管癌手术患者术后血清中S100β蛋白、NSE蛋白水平的升高,从而降低POCD的发生率,DEX效果更好,但两药联用效果并不理想。Objective To compare the effects of sevoflurane pretreatment and dexmedetomidine(DEX)on postoperative cognitive dysfunction(POCD)in elderly patients with surgery for esophageal carcinoma,and to explore its possible mechanism.Methods A total of 120 patients who underwent esophageal carcinoma were assigned to the following four groups(n=30 for each group):control group,sevoflurane group,DEX group and DEX+sevoflurane group.Before intravenous induction,control group accepted to inhale oxygen,sevoflurane group accepted to pretreat with sevoflurane,DEX group accepted to inhale oxygen and to pretreat with DEX,and DEX+sevoflurane group accepted to pretreat with sevoflurane and DEX.The heart rate(HR)and mean arterial pressure(MAP)before anesthesia administration,after the intubation and extubation were observed in the four groups.The 48 h VAS scores and POCD incidence at 1 d,3 d and 7 d after operation were compared between the four groups.The S100βand NSE protein concentrations were measured by ELISA before anesthesia administration,after extubation and the 1 st,3 rd,and 7 th postoperative days.Results There was no interaction between sevoflurane and DEX on HR and MAP during the experiment(P>0.05).Compared with the control group,the HR decreased in the sevoflurane pretreatment group only after the intubation(P<0.05),and the HR and MAP decreased in DEX group after the intubation and at the time of extubation(P<0.05).There was no significant difference in the proportion of patients with satisfactory and analgesia ratio in sevoflurane group 48 h after surgery(P>0.05).Compared with the control group and sevoflurane group,the proportion of patients with satisfactory and analgesia ratio increased in Dex group and Dex+sevoflurane group,while the proportion of patients with 4-10 scores decreased(P<0.05).Compared with the control group,the incidence of POCD one day after surgery was decreased in the sevoflurane group,the incidence of POCD 1 d and7 d after surgery was decreased in the DEX group,and the incidence of POCD 1 d,3 d a

关 键 词：食管肿瘤 老年人 认知功能障碍 麻醉药 联用 右美托咪定 S100钙结合蛋白β亚基 磷酸丙酮酸水合酶 七氟烷 

分 类 号：R614.2[医药卫生—麻醉学]