非气管插管麻醉对胸腔镜肺叶切除术后患者认知功能及血清MMP-9、脂联素的影响  

Effects of Non-tracheal Intubation Anesthesia on Cognitive Function and Serum MMP-9 and Adiponectin in Patients After Video-assisted Thoracoscopic Surgery Lobectomy

作　　者：杜巍[1] 谢海辉[2] 卢星照[1] 陈国标[1] 黄锡安[1] 郭裕良 扶志敏 彭山攀 DU Wei;XIE Haihui;LU Xingzhao;CHEN Guobiao;HUANG Xi′an;GUO Yuliang;FU Zhimin;PENG Shanpan(Department of Cardiothoracic Surgery,Dongguan People′s Hospital/the Tenth Affiliated Hospital of Southern Medical University,Dongguan 523016,Guangdong,China;Department of Anesthesiology,Dongguan People′s Hospital/the Tenth Affiliated Hospital of Southern Medical University,Dongguan 523016,Guangdong,China)

机构地区：[1]东莞市人民医院/南方医科大学附属第十医院胸心外科,广东东莞523016 [2]东莞市人民医院/南方医科大学附属第十医院麻醉科,广东东莞523016

出　　处：《医学信息》2025年第5期89-93,共5页Journal of Medical Information

基　　金：东莞市社会科技发展(重点)项目(编号:202050715001207)。

摘　　要：目的探讨采用非气管插管麻醉方式对胸腔镜肺叶切除手术后患者认知功能以及血清基质金属蛋白酶-9(MMP-9)和脂联素(ADP)浓度的影响。方法选择2022年1月-12月我院60例拟行电视胸腔镜(VATS)肺叶切除术患者60例,随机均分为非插管自主呼吸麻醉VATS组(观察组)和常规插管麻醉VATS组(对照组),每组30例。比较两组麻醉手术期间生命体征指标、动脉血氧指标、麻醉时间、手术时间、术后麻醉苏醒情况。采用简易精神状态检查量表(MMSE)于术前24 h、术后24 h、72 h对两组患者认知功能进行评估。记录两组患者术后POCD情况。采用酶联免疫吸附法于手术切皮前30 min、术后24 h分别采集静脉血样检测血清MMP-9、ADP浓度。结果两组手术麻醉前后平均动脉压、心率、PaO_(2)、SpO_(2)、PaCO_(2)、麻醉时间、手术时间、术中失血量比较,差异无统计学意义(P>0.05)。观察组术后呼之可睁眼时间、定向力恢复时间均短于对照组(P<0.05)。两组手术后24、72h的MMSE评分低于术前,观察组术后MMSE评分高于对照组(P<0.05)。与术前(切皮前30 min)比较,两组术后血清MMP-9浓度升高,ADP浓度降低(P<0.05)。观察组术后24 h血清MMP-9浓度低于对照组,血清ADP浓度高于对照组(P<0.05)。结论非插管自主呼吸麻醉方式应用于电视胸腔镜肺叶切除手术中能够保证麻醉效果,维持生命体征和动脉血氧指标稳定,可以加快术后苏醒,可能通过抑制MMP-9表达和促进ADP分泌,减轻术后认知功能障碍。Objective To investigate the effects of non-tracheal intubation anesthesia on cognitive function and serum concentrations of matrix metalloproteinase-9(MMP-9)and adiponectin(ADP)in patients after video-assisted thoracoscopic surgery lobectomy.Methods From January to December 2022,sixty patients undergoing video-assisted thoracoscopic surgery(VATS)lobectomy in our hospital were randomly divided into non-intubated spontaneous breathing anesthesia VATS group(observation group)and conventional intubation anesthesia VATS group(control group),with 30 patients in each group.The vital signs,arterial blood oxygen index,anesthesia time,operation time and postoperative anesthesia recovery were compared between the two groups.Mini-mental state examination(MMSE)was used to evaluate the cognitive function of the two groups at 24 h before operation,24 h and 72 h after operation.The postoperative POCD of the two groups was recorded.Venous blood samples were collected 30 min before skin incision and 24 h after operation to detect serum MMP-9 and ADP concentrations by enzyme-linked immunosorbent assay.Results There were no significant difference in mean arterial pressure,heart rate,PaO_(2),SpO_(2),PaCO_(2),anesthesia time,operation time and intraoperative blood loss between the two groups before and after anesthesia(P>0.05).The postoperative eye opening time and orientation recovery time in the observation group were shorter than those in the control group(P<0.05).The MMSE score of the two groups at 24 and 72 h after operation was lower than that before operation,and the MMSE score of the observation group was higher than that of the control group(P<0.05).Compared with preoperative(30 min before skin incision),the serum MMP-9 concentration was increased and the ADP concentration was decreased in the two groups after operation(P<0.05).The serum MMP-9 concentration at 24 h after operation in the observation group was lower than that in the control group,and the serum ADP concentration was higher than that in the control group(P<0.05

关 键 词：非气管插管麻醉 胸腔镜手术 术后认知功能障碍 基质金属蛋白酶-9 脂联素 

分 类 号：R655.3[医药卫生—外科学]