右美托咪啶对老年腹腔镜全身麻醉患者认知功能及外周血淋巴细胞PI3K/Akt信号通路的影响  

Effect of dexmedetomidine on cognitive function and peripheral blood lymphocyte PI3K/Akt signaling pathway in elderly patients undergoing laparoscopic general anesthesia

作　　者：刘丹[1] 周启 袁双 何慧鑫[1] LIU Dan;ZHOU Qi;YUAN Shuang(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

出　　处：《临床和实验医学杂志》2025年第2期211-215,共5页Journal of Clinical and Experimental Medicine

基　　金：湖南省自然科学基金科卫联合项目(编号:2023JJ60347);湖南中医药大学校级课题项目(编号:2020XJJJ048)。

摘　　要：目的探讨右美托咪定对老年腹腔镜全身麻醉患者认知功能及外周血淋巴细胞磷脂酰肌醇3激酶(PI3K)/蛋白激酶B(Akt)信号通路的影响。方法前瞻性选取2022年12月至2024年4月湖南中医药大学第一附属医院行腹腔镜全身麻醉手术老年患者84例作为研究对象,以抽签随机分为研究组(n=42)、对照组(n=42)。两组患者均行气管插管全身麻醉,插管成功后研究组静脉泵注0.25μg·kg^(-1)·h^(-1)的右美托咪定,对照组泵注同等剂量的0.9%氯化钠注射液,均在术毕前30 min停止泵注。比较两组诱导前(T_(0))、插管后(T_(1))、拔管时(T_(2))、拔管后10 min(T_(3))的心率、平均动脉压(MAP)变化,术后2、6、12 h时视觉模拟评分法(VAS)评分,术前,术后1、3 d时简易精神状态量表(MMSE)评分,术前、术后1 d时PI3K、Akt、Bal、Bax蛋白表达量及不良反应。结果两组患者心率、MAP水平均有时间、组间、交互效应差异,且研究组T_(0)~T_(2)时MAP、心率水平变化相对稳定,对照组T_(0)~T_(2)时MAP、心率变化显著,差异均有统计学意义(P<0.05)。术后6、12 h时,两组VAS评分均较术后2 h降低,且研究组术后2、6、12 h时VAS评分分别为(3.01±0.53)、(3.20±0.55)分,均较对照组[(3.43±0.57)、(3.62±0.59)分]低,差异均有统计学意义(P<0.05)。研究组术后1、3 d的MMSE评分与术前比较,差异均无统计学意义(P>0.05);对照组术后1、3 d的MMSE评分均较术前降低,差异均有统计学意义(P<0.05);研究组术后1 d的MMSE评分为(27.11±5.12)分,较对照组[(24.33±5.05)分]高,差异有统计学意义(P<0.05);术后3 d的MMSE评分与对照组比较,差异无统计学意义(P>0.05)。术后1 d,两组的PI3K、Akt、Bal水平均较术前降低,Bax水平均较术前升高,差异均有统计学意义(P<0.05);但研究组术后1 d的PI3K、Akt、Bal水平分别为0.79±0.21、1.08±0.25、0.91±0.22,均高于对照组(0.66±0.18、0.93±0.17、0.80±0.17),Bax水平为0.61±0.17,低于对照组(0Objective To exploring the effects of dexmedetomidine on cognitive function and peripheral blood lymphocyte phosphatidylinositol 3-kinase(PI3K)/protein kinase B(Akt)signaling pathway in elderly patients undergoing laparoscopic general anesthesia.Methods A total of 84 elderly patients who underwent laparoscopic general anesthesia surgery at the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine from December 2022 to April 2024 were prospectively selected as subjects,and were divided into the study group(n=42)and the control group(n=42)by drawing lots.Both groups of patients underwent general anesthesia with endotracheal intubation.After successful intubation,the study group received intravenous infusion of 0.25μg·kg^(-1)·h^(-1)dexmedetomidine,while the control group received the same dose of 0.9%sodium chloride injection.The infusion was stopped 30 minutes before surgery.Compare the hemodynamics[heart rate,mean arterial pressure(MAP)]of two groups of patients before anesthesia induction(T_(0)),at the completion of intubation(T_(1)),immediately after extubation(T_(2)),and 10 minutes after extubation(T_(3)),as well as the visual analog scale(VAS)scores at 2,6,and 12 h after surgery,the Mini Mental State Examination(MMSE)scores before surgery,1,3 d after surgery,and the expression levels and adverse reactions of PI3K,Akt,Bal,and Bax proteins before surgery and 1 day after surgery.Results The heart rate and MAP levels of the two groups were different in time,group and interaction effects,and the changes of MAP and heart rate levels at T_(0)-T_(2)in the study group were relatively stable,and the changes of MAP and heart rate at T_(0)-T_(2)in the control group were significant,the differences were statistically significant(P<0.05).At 6 and 12 h after surgery,the VAS scores of the two groups were lower than those at 2 h after operation,and the VAS scores of the study group at 2,6 and 12 h after surgery were(3.01±0.53)and(3.20±0.55)points,respectively,which were lower than those of the cont

关 键 词：右美托咪定 磷脂酰肌醇3激酶 蛋白激酶B 老年腹腔镜手术 认知功能 

分 类 号：R614.2[医药卫生—麻醉学]