艾司氯胺酮复合丙泊酚麻醉对老年乳腺癌根治术患者应激水平认知功能及血清BDNF NSE水平的影响  

Effects of Es-ketamine Combined with Propofol Anesthesia on Stress Levels Cognitive Function,and Serum BDNF and NSE Levels in Elderly Patients Undergoing Radical Mastectomy for Breast Cancer

作　　者：彭昌盛 周建军[1] 胡旭华[1] 金明 PENG Changsheng;ZHOU Jianjun;HU Xuhua(The First People's Hospital of Xiantao City,Hubei Xiantao 433000,China)

机构地区：[1]湖北省仙桃市第一人民医院麻醉科,湖北仙桃433000

出　　处：《河北医学》2024年第6期1049-1053,共5页Hebei Medicine

基　　金：湖北省卫生健康委员会科研项目,(编号:WJ2019H256)。

摘　　要：目的:探究艾司氯胺酮复合丙泊酚麻醉对老年乳腺癌根治术患者应激水平、认知功能及血清BDNF、NSE水平的影响。方法:选取2020年5月至2022年7月于本院进行乳腺癌根治术90例老年患者,根据随机数字表法将其进一步分为观察组(45例,艾司氯胺酮联合丙泊酚)和对照组(45例,丙泊酚麻醉)。比较两组患者应激水平、认知功能及血清BDNF、NSE水平。结果:观察组T2、T3、T4时间点皮质醇、肾上腺素水平相较于T0时间点均明显升高(P<0.05);对照组T1、T2、T3、T4时间点皮质醇、肾上腺素水平相较于T0时间点均明显升高(P<0.05);观察组T1、T2、T3、T4时间点皮质醇、肾上腺素水平升高幅度相较于对照组均明显降低(P<0.05);两组术后24h、48h认知功能评分及BDNF水平下降,NSE水平上升,且观察组变化优于对照组(P<0.05);观察组苏醒、拔管及定向力恢复时间相较于对照组均明显缩短(P<0.05)。结论:艾司氯胺酮复合丙泊酚麻醉老年乳腺癌根治术患者可减轻机体应激反应、加快认知功能恢复、改善术后苏醒质量。Objective:To investigate the effects of es-ketamine combined with propofol anesthesia on stress levels,cognitive function,and serum BDNF and NSE levels in elderly patients undergoing radical mastectomy for breast cancer.Methods:Ninety elderly patients who underwent radical mastectomy for breast cancer at our hospital from May 2020 to July 2022 were selected and further divided into the observation group(45 cases,es-ketamine combined with propofol)and the control group(45 cases,propofol anesthesia)according to a random number table method.The stress levels,cognitive function,and serum BDNF and NSE levels of the two groups were compared.Results:In the observation group,cortisol and adrenaline levels at T2,T3,and T4 time points were significantly higher compared to T0 time point(P<0.05).In the control group,cortisol and adrenaline levels at T1,T2,T3,and T4 time points were significantly higher compared to T0 time point(P<0.05).The increase in cortisol and adrenaline levels at T1,T2,T3,and T4 time points in the observation group was significantly lower than that in the control group(P<0.05).Both groups showed a decrease in cognitive function scores and BDNF levels and an increase in NSE levels at 24h and 48h postoperatively,with the observation group showing better changes than the control group(P<0.05).The awakening,extubation,and orientation recovery times in the observation group were significantly shorter than those in the control group(P<0.05).Conclusion:Es-ketamine combined with propofol anesthesia in elderly patients undergoing radical mastectomy for breast cancer can reduce the body's stress response,accelerate cognitive function recovery,and improve the quality of postoperative awakening.

关 键 词：老年乳腺癌根治术 丙泊酚 艾司氯胺酮 应激水平 认知功能 

分 类 号：R614[医药卫生—麻醉学] R737.9[医药卫生—外科学]