依托咪酯对老年患者血清炎性因子及术后早期认知功能的影响

发布时间：2018-11-16 19:45

【摘要】：目的：探讨依托咪酯对老年患者腹部手术血清炎性因子及术后早期认知功能的影响。方法：选择60岁以上择期全麻下行腹部手术老年患者40例，采用随机数字表法将患者分为试验组(E组)和对照组(P组)各20例，采用随机对照试验。E组采用依托咪酯全凭静脉麻醉，P组采用丙泊酚全凭静脉麻醉。对两组分别于术前24h(T0)、手术结束时（T2）、术后2h(T3)及24h(T4)抽取外周静脉血5ml，采用酶联免疫吸附法(ELISA)测定白细胞介素6（IL-6）、白细胞介素-10（IL-10）、肿瘤坏死因子-α(TNF-α)浓度。采用简易精神状态检查表(MMSE)分别于术前24h（M1）和术后24h（M2）进行评分。观察两组患者术后24h有无早期认知功能障碍，观察并记录两组麻醉诱导前后及术后血流动力学变化、手术时间、苏醒时间、出血量、尿量、输液量。结果：两组炎性因子的比较，组内比较：两组T2、T3和T4时点患者血清IL-6、IL-10浓度较T0时点显著升高（P＜0.01），两组T2、T3时点患者血清TNF-α浓度较T0时点显著升高（P＜0.01），两组T4时点患者血清TNF-α浓度与T0时点比较无统计学意义（P＞0.05）；两组T3时点较T2时点及T4时点较T3时点患者血清IL-6和TNF-α浓度均显著降低（P＜0.01）；两组T3时点患者血清IL-10浓度较T2时点升高（P＜0.05）；T4时点患者血清IL-10浓度较T3时点明显降低（P＜0.01）。组间比较：E组T2和T3时点的患者血清IL-6和TNF-α浓度较P组显著增高（P＜0.05），IL-10浓度较对照组显著降低（P＜0.05）；两组间其余各时点患者血清IL-6、IL-10和TNF-α浓度比较差异无统计学意义（P＞0.05）。两组术后24h MMSE评分均较术前24h下降（P＜0.05）,两组术前和术后患者MMSE评分比较差异无统计学意义（P＞0.05）。E组POCD发生率为50.0%，P组患者POCD发生率为36.8%，两组POCD发生率比较差异无统计学意义（P＞0.05）。结论：依托咪酯在抑制促炎因子的释放和促进抑炎因子的分泌方面较丙泊酚弱，这种作用效果是短暂的，在术后24小时无差异。依托咪酯与丙泊酚比较，，不会增加POCD的发生率。对于老年患者，依托咪酯仍可作为首选静脉麻醉药。
[Abstract]:Objective: to investigate the effect of etomidate on serum inflammatory factors and early postoperative cognitive function in elderly patients undergoing abdominal surgery. Methods: forty elderly patients with abdominal surgery under elective general anesthesia over 60 years of age were selected. The patients were randomly divided into two groups: experimental group (group E) and control group (group P). Group E received total intravenous anesthesia with etomidate and group P with total intravenous anesthesia with propofol. Peripheral venous blood was extracted 24 hours before operation (T0), at the end of operation (T2), 2 hours after operation (T3) and 24 hours after operation (T4). Interleukin 6 (IL-6) was measured by enzyme linked immunosorbent assay (ELISA). Interleukin-10 (IL-10), tumor necrosis factor-伪 (TNF- 伪) concentration. (MMSE) was scored 24 hours before operation (M1) and 24 hours after operation (M2). The changes of hemodynamics, operation time, recovery time, blood loss, urine volume and infusion volume were observed and recorded before and after anesthesia induction in both groups. Results: the comparison of inflammatory factors between the two groups, intra-group comparison: the serum IL-6,IL-10 concentration of the patients at T _ 2T _ 3 and T _ 4 was significantly higher than that at T _ 0 (P < 0. 01). The serum TNF- 伪 concentration at T3 time point was significantly higher than that at T0 time point (P < 0. 01), but there was no significant difference between the two groups at T 4 time point and T 0 time point (P > 0. 05). The levels of serum IL-6 and TNF- 伪 in T3 group were significantly lower than those in T2 time point and T4 time point (P < 0. 01), and the serum IL-10 concentration in T3 time group was higher than that in T2 time point (P < 0. 05). The serum IL-10 concentration at T 4 time point was significantly lower than that at T 3 time point (P < 0 01). The serum levels of IL-6 and TNF- 伪 were significantly higher in group E than those in group P (P < 0. 05), and the concentration of IL-10 was significantly lower than that in control group (P < 0. 05). There was no significant difference in serum IL-6,IL-10 and TNF- 伪 levels between the two groups at other time points (P > 0. 05). The MMSE score at 24 hours after operation in both groups was lower than that in preoperative 24 hours (P < 0. 05). There was no significant difference in MMSE score between the two groups before and after operation (P > 0. 05). E group, the incidence of POCD was 50. 0%, P < 0. 05). The incidence of POCD in group P was 36.8 and there was no significant difference in the incidence of POCD between the two groups (P > 0. 05). Conclusion: etomidate is weaker than propofol in inhibiting the release of proinflammatory factor and promoting the secretion of propofol. Etomidate does not increase the incidence of POCD compared with propofol. Etomidate can still be used as the first choice for intravenous anesthesia in elderly patients.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614.24

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