七氟醚联合丙帕他莫对老年腹腔镜手术患者mTOR/Grb信号通路及认知功能的影响  

Effects of sevoflurane combined with propafenone on the mTOR/Grb signaling pathway and cognitive function in elderly patients undergoing laparoscopic surgery

作　　者：何慧鑫[1] 廖小棋 刘丹[1] 蔡亚宏[2] HE Hui-xin;LIAO Xiao-qi;LIU Dan(Department of Anesthesia Surgery,The First Affiliated Hospital of Hunan University of Traditional Chinese Medicine,Changsha Hunan 410007,China)

机构地区：[1]湖南中医药大学第一附属医院麻醉手术科,湖南长沙410007 [2]湖南中医药大学第一附属医院慢病管理科,湖南长沙410007

出　　处：《临床和实验医学杂志》2024年第19期2119-2123,共5页Journal of Clinical and Experimental Medicine

基　　金：湖南省自然科学基金面上项目(编号:2020JJ4474);湖南中医药大学校级联合科研基金(编号:2020XJJJ048)。

摘　　要：目的探讨七氟醚联合丙帕他莫对老年腹腔镜手术患者认知功能、雷帕霉素靶蛋白(mTOR)/生长因子受体结合蛋白(Grb)信号通路的影响。方法前瞻性纳入2022年1月至2023年10月在湖南中医药大学第一附属医院择期行腹腔镜手术的82例老年患者作为研究对象,按随机数表方式将其分为对照组、观察组,每组各41例。两组均行腹腔镜下胆囊切除术。麻醉诱导前15 min,对照组给予帕瑞昔布钠镇痛,观察组给予丙帕他莫镇痛,两组均给予七氟醚行麻醉维持。评估并比较两组患者术前、术后1、6、12 h的视觉模拟评分法(VAS)、镇静评分量表(Ramsay)、简易精神状态检查量表(MMSE),同时检测其术前、术后12 h的外周血mTOR、Grb蛋白表达水平,另比较两组患者麻醉诱导前(T 0)、术后1 h(T 1)、术后6 h(T 2)、术后12 h(T 3)的血流动力学指标[平均动脉压(MAP)、心率、动脉血氧饱和度(SpO_(2))]。结果术后1、6、12 h,两组VAS评分均低于术前,且观察组VAS评分均低于对照组,差异均有统计学意义(P<0.05)。术后1、6、12 h,两组Ramsay评分均高于术前,且观察组Ramsay评分均高于对照组,差异均有统计学意义(3 P<0.05)。术后1、6、12 h,两组MMSE评分均低于术前,且观察组MMSE评分均低于对照组,差异均有统计学意义(P<0.05)。术后12 h,两组外周血mTOR蛋白表达水平高于术前,Grb蛋白表达水平低于术前,且观察组外周血mTOR蛋白表达水平高于对照组,Grb蛋白表达水平低于对照组,差异均有统计学意义(P<0.05)。T_(1)、T_(2)、T^(3),两组的MAP、心率均较T_(0)降低,且观察组各时点MAP、心率指标均高于对照组,差异均有统计学意义(P<0.05)。结论七氟醚联合丙帕他莫用于老年患者腹腔镜手术镇痛、镇静效果较好,并能通过mTOR/Grb信号通路减轻对其认知功能的损伤,且对患者血流动力学影响较小。Objective To explore the effects of sevoflurane combined with propafenone on cognitive function and mammalian target of rapamycin(mTOR)/growth factor receptor binding protein(Grb)signaling pathway in elderly patients undergoing laparoscopic surgery.Methods A prospective study was conducted on 82 elderly patients who underwent laparoscopic surgery at the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine from January 2022 to October 2023.They were randomly divided into a control group and an observation group,with 41 patients in each group.Both groups underwent laparoscopic cholecystectomy.15 minutes before anesthesia induction,the control group was given parecoxib sodium for pain relief,the observation group was given propranolol for pain relief,and both groups were given sevoflurane for anesthesia maintenance.The pain visual analogue scale(VAS),Ramsay sedation scale(Ramsay)and mini-mental state examination(MMSE)were evaluated and compared between the two groups before operation and at 1,6 and 12 h after operation,at the same time,the expression levels of mTOR and Grb protein in peripheral blood were detected before and 12 h after operation.Additionally,the hemodynamic indicators of mean arterial pressure(MAP),heart rate,and arterial oxygen saturation(SpO_(2))before anesthesia induction(T 0),1 h after operation(T 1),6 h after operation(T 2),12 h after operation(T 3)between the two groups of patients were compared.Results At 1,6 and 12 h after operation,the VAS scores of the two groups were lower than those before operation,and the VAS scores of the observation group were lower than those of the control group,the differences were statistically significant(P<0.05).At 1,6 and 12 h after operation,the Ramsay scores of the two groups were higher than those before operation,and the Ramsay scores of the observation group were higher than those of the control group,the differences were statistically significant(P<0.05).At 1,6 and 12 h after operation,the MMSE scores of the two groups were lower

关 键 词：七氟醚 丙帕他莫 腹腔镜手术 雷帕霉素靶蛋白 生长因子受体结合蛋白 认知功能 老年人 

分 类 号：R614[医药卫生—麻醉学]