七氟醚吸入麻醉对老年患者食管癌切除术后认知功能的影响

发布时间：2018-07-01 11:10

本文选题：七氟醚 + 老年患者　；参考：《山东大学》2014年硕士论文

【摘要】：目的：术后认知功能障碍(postoperative cognitive dysfunction, POCD)是指麻醉手术后引起的神经认知功能紊乱,表现为性格改变、学习记忆能力下降及认知能力异常等中枢神经系统功能障碍,严重的可出现痴呆。这一麻醉手术后的并发症常发生于术后数周或数月,少数人可长期存在,可以影响患者的学习记忆、社会活动,给社会及家庭带来沉重的负担。近年来,随着人口的老龄化,经历麻醉和手术的病人中老年患者的比例在逐年升高,POCD的发病率也在逐年上升。因此,探讨POCD的发病机制及防治措施具有重要经济社会意义。本文旨在探讨七氟醚吸入麻醉下老年食管癌患者根治术后认知功能的变化情况。方法：选择我院(山东大学第二医院)62-75岁ASA Ⅰ-Ⅱ级的老年食管癌患者60例,随机分为七氟醚吸入麻醉组(S组)和对照组(Con组),每组患者30例。两组患者入室后开放静脉通路,监测无创血压(NIBP).心率(HR)、脉搏血氧饱和度(Sp02)、心电图(ECG)、呼气末二氧化碳分压(PETCO2)。麻醉诱导：长托宁0.01-0.02mg/kg,咪达唑仑2-3mg,依托咪酯0.2-0.4mg/kg,舒芬太尼0.3-0.6μg/kg,苯磺顺阿曲库胺0.2-0.4mg/kg,及艾司洛尔0.2-0.4μg/mg。插管成功后接麻醉机,调节呼吸参数：潮气量(VT)8-10ml/kg,呼吸频率(RR)10-12次份,PETCO235-40mm Hg。术中S组予1-1.3MAC七氟醚,而Con组予靶控输注2～4u g/mL异丙酚维持麻醉,手术开始时追加舒芬太尼5-10μ g,按需追加苯磺顺阿曲库胺。依脑电双频指数(BIS)、血流动力学改变及手术刺激强度调整麻醉深度。术中BIS值维持在50～60,BP低于基础值20%予以麻黄碱,高于基础值20%予以降压处理；HR低于50次/分给予阿托品处理。当开始缝合时停止七氟醚吸入和异丙酚靶控输注。所有患者术后均应用患者自控静脉镇痛(PCIA):诺扬10mg加凯纷100mg,手术结束时给负荷量2mL,持续输注2mL/h,自控量4mL,锁定时间15min。分别在TO(入室),T1(插管),T2(切皮开腹时),T3(关腹缝皮时)、T4(拔管)时间点记录平均动脉压(MAP),心率(HR)。分别于手术开始前,手术结束后1d,手术结束后5d抽取2-4m1静脉血,用ELISA法测定血浆中IL-6、TNF-α、S-100β蛋白的浓度。记录手术结束后自主呼吸恢复时间、轻唤睁眼时间及拔管时间。于术前1天访视病人时测定一次简易智能量表MMSE和MoCA,术后5天、术后10天各测一次对认知功能进行评估。结果： 1.两组患者的术前一般情况的差异无统计学意义(P0.05)。 2.两组患者不同时间点MAP、HR的比较,组内比较差异有统计学意义(P0.05),而组间同一时间点比较差异无统计学意义(P0.05)。 3.两组患者自主呼吸恢复时间、睁眼时间、拔管时间比较差异均无统计学意义(P0.05)。 4.两组患者术后IL-6及S-100β蛋白的血浆浓度均较术前明显增高(P0.05)。术后ldS组的IL-6的血浆浓度明显高于Con组(P0.05)。术后5d的S组的S-100β蛋白的血浆浓度高于Con组,P0.05。 5.与术前基础值比较,两组患者术后第1或5天MMSE评分明显下降(P0.05)。两组患者术前MMSE评分比较差异无统计学意义(P0.05),但S组术后第1或5天MMSE和MoCA评分均有明显低于Con组(P0.05)。结论：七氟醚吸入麻醉可引起老年食管癌根治术患者术后早期认知功能的降低,这可能与炎症反应和S-100β蛋白有关。。
[Abstract]:Objective:
Postoperative cognitive dysfunction (postoperative cognitive dysfunction, POCD) refers to neurocognitive dysfunction caused by anaesthesia, characterized by character change, decline in learning and memory and abnormal cognitive ability, and serious dementia. The postoperative complications often occur after the operation. For several weeks or months, a few people can exist for a long time, which can affect the learning and memory of the patients, social activities, and bring a heavy burden to the society and the family. In recent years, with the aging of the population, the proportion of the elderly patients undergoing anesthesia and surgery is increasing year by year, and the incidence of POCD is increasing year by year. Therefore, the pathogenesis of POCD is discussed. The purpose of this study is to explore the changes of cognitive function after radical resection of esophageal cancer in elderly patients under sevoflurane inhalation anesthesia.
Method:
60 cases of elderly esophageal cancer at the age of 62-75 years ASA I - II in our hospital (Second Hospital of Shandong University) were randomly divided into the sevoflurane inhalation anesthesia group (group S) and the control group (group Con), with 30 cases in each group. The two groups were open to the open vein after admission to monitor non invasive blood pressure (NIBP), heart rate (HR), pulse oxygen saturation (Sp02), electrocardiogram (ECG), end expiratory (ECG), and end of breath. Carbon dioxide partial pressure (PETCO2). Anesthesia induction: Chang toning 0.01-0.02mg/kg, midazolam 2-3mg, etomidate 0.2-0.4mg/kg, sufentanil 0.3-0.6 mu g/kg, benzenesonatracurium 0.2-0.4mg/kg, and esmolol 0.2-0.4 u g/mg. intubation after the success of the anesthesia machine, regulating the respiratory parameters: tidal volume (VT) 8-10ml/kg, respiratory frequency (RR) 10-12 copies Group S in ETCO235-40mm Hg. was given 1-1.3MAC sevoflurane, and group Con was administered by target controlled infusion of 2 ~ 4U g/mL propofol to maintain anaesthesia. At the beginning of the operation, sufentanil was added to 5-10 mu of sufentanil, and in accordance with the need to add benzonatracuramide, according to the bispectral index (BIS), hemodynamic changes and surgical stimulation intensity to adjust the depth of anesthesia. The value of BIS in the operation was maintained at 50~60, BP. Lower than 20% of base value given ephedrine, higher than the base value of 20% for depressurization; HR was lower than 50 to atropine treatment. Sevoflurane inhalation and propofol target infusion were stopped when the suture began. All patients were treated with intravenous analgesia (PCIA) after operation: noyang 10mg plus Kay 100mg, the load was 2mL, continuous infusion at the end of the operation. Note 2mL/h, control volume 4mL, lock time 15min.
The average arterial pressure (MAP) and heart rate (HR) were recorded at the TO (entrance), T1 (intubation), T2 (when the skin cut off the skin), and the time point of T4 (extubation). At the end of the operation, after the operation, 1D and 2-4m1 venous blood were extracted from 5D after the operation. The concentration of IL-6, alpha, and beta protein in plasma was measured by ELISA method. The time of respiration recovery, the time of eye opening and opening, and the time of extubation were measured. A simple intelligent scale MMSE and MoCA were measured at 1 days before the operation, and the cognitive function was assessed at the 5 day after the operation and 10 days after the operation.
Result:
1. there was no significant difference in the general condition between the two groups (P0.05).
2. the comparison of MAP and HR at different time points in the two groups was statistically significant (P0.05), but there was no significant difference between the groups at the same time point (P0.05).
3. there was no significant difference in spontaneous breathing recovery time, eye opening time and extubation time between the two groups (P0.05).
4. the plasma concentration of IL-6 and S-100 beta protein in the two groups was significantly higher than that before operation (P0.05). The plasma concentration of IL-6 in group ldS was significantly higher than that in group Con (P0.05). The plasma concentration of S-100 beta protein in group S after operation was higher than that in Con group.
5. compared with the preoperative basic values, the MMSE scores of the two groups were significantly decreased (P0.05) on first or 5 days after operation. There was no statistical difference between the two groups before operation (P0.05), but the MMSE and MoCA scores in the S group were significantly lower than those in the Con group (P0.05) at first or 5 days after operation.
Conclusion:
Sevoflurane inhalation anesthesia can cause early postoperative cognitive dysfunction in elderly patients undergoing radical resection of esophageal cancer, which may be related to inflammatory reaction and S-100 beta protein.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614;R735.1

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