远隔缺血预处理对老年肝癌切除术后影响的研究  

Effect of remote ischemic preconditioning on elderly patients with liver cancer after hepatectomy

作　　者：范玲玲[1] 丁翠霞[1] 都义日[1] 陈冬梅[1] FAN Ling-ling;DING Cui-xia;DU Yi-ri;CHEN Dong-mei(Department of Anesthesiology,Affiliated Hospital of Inner Mongolia Medical University,Hohhot Inner Mongolia 010059,China)

机构地区：[1]内蒙古医科大学附属医院麻醉科,内蒙古呼和浩特010059

出　　处：《局解手术学杂志》2023年第2期138-142,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：内蒙古自治区自然科学基金(2017MS0832)。

摘　　要：目的探究远隔缺血预处理对老年原发性肝癌切除术后炎症与氧化应激反应、认知功能障碍以及并发症的影响。方法随机选择2018年11月至2020年7月在本院进行肝癌手术的82例老年患者为研究对象,按照随机数字表法分为观察组和对照组,每组41例。观察组患者在麻醉诱导后、手术开始前开展肢体远隔缺血预处理,对照组患者在麻醉诱导后、手术开始前不进行肢体远隔缺血预处理。分析远隔缺血预处理对患者术后产生的影响。结果2组患者术后蒙特利尔认知量表(MoCA)评分、简易精神状态检查量表(MMSE)评分、S100β蛋白、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、8-异-前列腺素F_(2α)(8-iso-PGF_(2α))、脑氧摄取率(CERO_(2))、颈内动-静脉血氧含量差(AVDO_(2))相比,差异有统计学意义(P<0.05);观察组患者术后第1天、第7天的QoR-15评分均低于对照组(P<0.05);2组患者术后颈内静脉球部血氧含量(CjvO_(2))相比,差异无统计学意义(P>0.05);与对照组比较,观察组患者术后住院时间更短(P<0.05),认知功能障碍发生率及并发症发生率更低(P<0.05)。结论远隔缺血预处理用于老年肝癌切除术患者,能够减轻炎症反应和氧化应激反应,降低术后早期认知功能障碍发生率及术后并发症发生率,有助于患者术后康复。Objective To explore the effect of remote ischemic preconditioning on the inflammation,oxidative stress,cognitive dysfunction and complications of elderly patients with primary liver cancer after hepatectomy.Methods A total of 82 patients who underwent liver cancer surgery in our hospital from November 2018 to July 2020 were selected as the research objects,and they were divided into the observation group and the control group according to random number table,with 41 cases in each group.Patients in the observation group were treated with limb remote ischemic preconditioning during the time from anesthesia induction to operation,while patients in the control group were not treated with limb remote ischemic preconditioning during the time from anesthesia induction to operation.The effects of remote ischemic preconditioning on patients after surgery were analyzed.Results There were significant differences in Montreal cognitiveassessment scale(MoCA)score,mini-mental state examination(MMSE)score,S100βprotein,tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),8-iso-prostaglandin F2α(8-iso-PGF_(2α)),cerebral ex-traction rate of oxygen(CERO_(2))and arterio-jugular difference of oxygen(AVDO_(2))after surgery between the two groups(P<0.05).The QoR-15 score on the first day and the seventh day after operation of the observation group were lower than those of the control group(P<0.05).There was no significant difference in the jugular veinoxygen content(CjvO_(2))after operation between the two groups(P>0.05).Compared with the control group,the hospitalization time in the observation group was shorter,the incidence of cognitive dysfunction and the complication rate in the observation group were lower(P<0.05).Conclusion Remote ischemic preconditioning for elderly patients with liver cancer surgery can relieve the inflammatory response and oxidative stress,reduce the incidence of early postoperative cognitive dysfunction and postoperative liver complication rate,which is conducive to postoperative rehabilitation.

关 键 词：远隔缺血预处理 老年患者 肝癌手术 认知功能障碍 炎症反应 氧化应激反应 

分 类 号：R735.7[医药卫生—肿瘤]