目的比较七氟烷和异氟烷麻醉对老年肺部肿瘤患者手术后早期认知功能的影响。方法60例老年肺部肿瘤患者随机分为七氟烷(Ⅰ组)和异氟烷麻醉组(Ⅱ组)。患者术前1d、出麻醉恢复室时、术后1d、3d和7d,用MMSE量表进行评分。认知功能障碍(postoperativecognitivedysfunction,POCD)判定,用Z计分法。患者术前1d、术后1h和1d各抽取静脉血5ml,用于测定血清白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)的含量。结果与术前1d(评分Ⅰ组:28.2±2.2,Ⅱ组:27.9±1.7)比较,Ⅰ组、Ⅱ组出麻醉恢复室时(评分Ⅰ组:25.2±2.2,Ⅱ组:24.9±1.9)、术后1d(评分Ⅰ组:22.7±3.0,Ⅱ组:21.8±3.2),评分降低(P<0.05);出麻醉恢复室时,Ⅰ组发生POCD12例(40.0%),Ⅱ组发生13例(32.5%),两组发生率比较差异无统计学意义;术后1、3、7d两组分别发生POCD为9、5、0例和9、5、1例。Ⅰ组、Ⅱ组在3d和7d认知功能基本恢复;Ⅰ组、Ⅱ组术后1h和1d时IL-6和TNF-α的含量明显增高(P<0.05)。结论两种麻醉方式术后早期均发生POCD,提示七氟烷和异氟烷麻醉对早期POCD发生率的影响无差异。IL-6、TNF-α升高是老年患者全麻下行肺部肿瘤手术后发生早期POCD的机制之一。
Abstract
Objective To compare different impacts of anesthesia on early cognitive function in elderly patients with lung cancer after surgery. Methods 60 cases of elective lung tumor patients (ASA<Ⅲ), 60 to 79 years old, able to effectively communicate with physicians, and MMSE scores> 24 points were recruited. The patients were randomly divided into 2 groups (n=30 each): sevoflurane group (group Ⅰ) and isoflurane group (group Ⅱ). For each group, on preoperative 1 d, leaving the anesthesia recovery room after surgery, 3 and 7 days after surgery. The Mini-mental State Examination (MMSE) was used to score cognitive function.The postoperative determine cognitive dysfunction (POCD) was determined by use of Z-scoring method. For the two groups of patients,on the day before surgery and postoperative 1 h and 1 d, venous blood 5 ml was exampled to do enzyme-linked immunosorbent assay (ELISA) for determining TNF-α and IL-6, in accordance with the instructions of the ELISA kit. Results Compared with preoperative 1 d (group Ⅰ: 28.2±2.2, group Ⅱ: 27.9±1.7), MMSE score decreased (group Ⅰ: 22.7±3.0, group Ⅱ: 21.8±3.2, P<0.05) in group Ⅰ and group Ⅱ when leaving the anesthesia recovery room 1 d after, and incidence of cognitive dysfunction increased (P<0.05). Compared with preoperative scores in group Ⅰ and group Ⅱ, leaving the PACU, MMSE score was lower (Ⅰ: 25.2±2.2, Ⅱ: 24.9±1.9, P<0.05) in postoperative 1 d; and there was no significant difference between the two groups. Although there was a slight decrease in 3 days (Ⅰ: 5, Ⅱ: 5) and 7 days (Ⅰ: 0, Ⅱ: 1) after the operation, compared with the preoperative scores, the difference was not statistically significant (P>0.05). IL-6 and TNF-α levels 1 h and 1 d after surgery were significantly higher than those 1 d before surgery , with statistically significant differences (P<0.05). Conclusions In elderly patients after receiving anesthesia and lung cancer surgery, when leaving recovery room, cognitive function declined at postoperative day 1 , and basically recovered three days to seven days after the operation. There was no difference in the anesthesia between the use of sevoflurane and isoflurane on cognitive dysfunction, which provides a variety of options for clinical senile anesthesia. Excessive lung tumors surgical stimulation and inflammatory cytokines may have impact on postoperative cognitive function.
关键词
全身麻醉 /
认知功能障碍 /
老年人 /
七氟烷 /
异氟烷
Key words
general anesthesia /
postoperative cognitive dysfunction /
elderly /
sevoflurane /
isoflurane
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