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.
Key words
general anesthesia /
postoperative cognitive dysfunction /
elderly /
sevoflurane /
isoflurane
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References
[1] Saravay S M, Kaplowitz M, Kurek J, et al. How do delirium and dementia increase length of stay of elderly general medical inpatients? [J]. Psychosomatics, 2004, 45(3): 235-242.
[2] Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2008 [J]. CA Cancer J Clin, 2008,58(2): 71-96.
[3] 张伟东, 苗树军. 我国恶性肿瘤死亡率流行病学特征分析[J]. 中国健康教育, 2009, 25(4): 246-248.
[4] Gao L, Taha R, Gauvin D, et al. Postoperative cognitive dysfunction after cardiac surgery [J]. Chest, 2005, 128(5): 3664-3670.
[5] 杨泽勇, 徐莹华, 费凤英, 等. 老年患者术后认知功能障碍与 IL-1β, IL-6 和 TNF-α 的表达 [J]. 临床麻醉学杂志, 2010(9): 764-766.
[6] Folstein M, Anthony J C, Parhad I, et al. The meaning of cognitive impairment in the elderly [J]. J Am Geriatr Soc, 1985, 33(4): 228-235.
[7] Folstein M F, Folstein S E, McHugh P R. “Mini-mental state”:a practical method for grading the cognitive state of patients for the clinician [J]. J Psychiatr Res, 1975, 12(3):189-198.
[8] 时胜男, 左明章, 李晓琳. 术中静脉输注利多卡因对老年患者全麻下非心脏手术后认知功能的影响[J]. 中华麻醉学杂志, 2009, 29(6): 575-576.
[9] Steinmetz J, Christensen K B, Lund T, et al. Long-term consequences of postoperative cognitive dysfunction [J]. Anesthesiology, 2009, 110(3): 548-555.
[10] Rasmussen L S, Johnson T, Kuipers H M, et al. Does anaesthesia cause postoperative cognitive dysfunction? A randomised study of regional versus general anaesthesia in 438 elderly patients [J]. Acta Anaesthesiol Scand, 2003, 47(3): 260-266.
[11] Morrison J H, Hof P R. Life and death of neurons in the aging brain [J]. Science, 1997, 278(5337): 412-419.
[12] Backman S B, Fiset P, Plourde G. Cholinergic mechanisms mediating anesthetic induced altered states of consciousness [J]. Prog Brain Res, 2004, 145: 197-206.
[13] 田首元. 静脉麻醉药对老龄大鼠认知功能的影响及海马的比较蛋白质组学研究[D]. 中国协和医科大学, 2010.
[14] 刘 伟, 饶丽华, 郭淑静, 等. 七氟醚复合丙泊酚静吸复合麻醉对老年食管癌患者术后早期认知功能的影响[J]. 临床麻醉学杂志, 2011, 27(4): 373-375.
[15] Delphin E, Jackson D, Gubenko Y, et al. Sevoflurane provides earlier tracheal extubation and assessment of cognitive recovery than isoflurane in patients undergoing off-pump coronary artery bypass surgery [J]. J Cardiothorac Vasc Anesth, 2007, 21(5): 690-695.
[16] Kanbak M, Saricaoglu F, Akinci SB, et al. The effects of isoflurane, sevoflurane, and desflurane anesthesia on neurocognitive outcome after cardiac surgery: a pilot study [J]. Heart Surg Forum, 2007, 10(1): E36-41.
[17] 王佩芳,异氟烷、七氟烷急性暴露对E17大鼠海马神经干细胞发育的影响及机制研究 [D]. 温州医学院, 2011.
[18] Wei H, Kang B, Wei W, et al. Isoflurane and sevoflurane affect cell survival and BCL-2/BAX ratio differently [J]. Brain Res, 2005, 1037(1-2):139-147.
[19] Wang Q J, Li K Z, Yao S L, et al. Different effects of isoflurane and sevoflurane on cytotoxicity [J]. Chin Med J (Engl), 2008, 121(4): 341-346.
[20] Rosczyk H A, Sparkman N L, Johnson R W. Neuroinflammation and cognitive function in aged mice following minor surgery [J]. Exp Gerontol, 2008, 43(9): 840-846.
[21] Godbout J P, Chen J, Abraham J, et al. Exaggerated neuroinflammation and sickness behavior in aged mice following activation of the peripheral innate immune system [J]. FASEB J, 2005, 19(10): 1329-1331.
[22] 刘九红, 田玉科. 异氟烷与七氟烷麻醉和手术对患者血清IL-2、IL-6水平的影响 [J]. 中华麻醉学杂志, 2000, 20(9): 568-569.
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