快速康复外科策略管理对老年患者术后认知功能的影响

发布时间：2019-02-09 12:12

【摘要】：目的研究麻醉管理中应用快速康复外科(ERAS)策略对老年患者术后认知功能的影响。方法选取牡丹江医学院红旗医院普外科老年腹部肿瘤患者86例,术前简易智力状态检查量表(MMSE)评分大于23分,按照随机数字表法分为ERAS组(E组)和对照组(C组)。E组采用ERAS策略对麻醉方法、镇痛、体温控制、每搏输出量变异度(SVV)监测下的限制输液等优化。C组采用一般性全身麻醉,无优化措施,传统4-2-1补液法。分别术前1d(T0)、术后6h(T1)、1d(T2)、2d(T3)、3d(T4)采集静脉血,用酶联免疫吸附法(ELISA)检测血清白细胞介素(IL)-6、肿瘤坏死因子-α(TNF-α)、S-100β蛋白水平。用MMSE和蒙特利尔认知评估量表(MOCA)检测认知功能。术中均监测鼻咽温度,记录患者住院时间。结果与C组比较,E组IL-6在T1、T3、T4降低(P0.05);TNF-α在T1~T3降低(P0.05);S-100β蛋白在T1~T4降低(P0.05);E组MOCA评分和MMSE评分在T1、T2、T4、T5均升高(P0.05)。E组鼻咽部温度在麻醉后1h、术毕、恢复室30min明显高于C组(P0.05),POCD发生率降低(P0.05),住院时间缩短(P0.05)。结论在老年手术患者麻醉管理中应用ERAS通过降低血清IL-6、TNF-α和S-100β蛋白水平进而降低术后认知功能障碍的发生率。
[Abstract]:Objective to study the effect of rapid rehabilitation surgery (ERAS) strategy on postoperative cognitive function in elderly patients in anesthetic management. Methods 86 elderly patients with abdominal tumor in general surgery department of Hongqi Hospital of Mudanjiang Medical College were selected. The (MMSE) score of the simple Mental State examination scale before operation was more than 23 points. According to the random number table method, ERAS group (E group) and control group (C group). E group) were divided into two groups: ERAS strategy, analgesia and body temperature control. The variation of output per stroke was optimized by limited infusion under (SVV) monitoring. Group C was treated with general anesthesia without optimization and conventional 4-2-1 rehydration method. Venous blood was collected 1 day before operation (T 0), 6 hours after operation (T 1), 1 day (T 2), 2 days (T 3), 3 days (T 4). Serum interleukin (IL) 6 and tumor necrosis factor 伪 (TNF- 伪) were detected by enzyme linked immunosorbent assay (ELISA). S-100 尾 protein level. Cognitive function was measured by MMSE and Montreal Cognitive Assessment scale (MOCA). The nasopharynx temperature was monitored and the hospitalization time was recorded. Results compared with group C, IL-6 in group E decreased in T1T3T4, TNF- 伪 in T1~T3 (P0.05), S-100 尾 protein in T1~T4 (P0.05). The MOCA score and MMSE score in group E were significantly higher than those in group C (P0.05). The nasopharyngeal temperature of group E was significantly higher than that of group C (P0.05) at 1 hour after anesthesia (P0.05), and the incidence of), POCD in group E was significantly higher than that in group C (P0.05). The hospitalization time was shortened (P0.05). Conclusion ERAS can reduce the incidence of postoperative cognitive dysfunction by reducing the levels of serum IL-6,TNF- 伪 and S-100 尾 protein in elderly patients undergoing anesthesia management.
【作者单位】：牡丹江医学院红旗医院麻醉科;黑龙江省牡丹江市第二人民医院麻醉科;牡丹江医学院教务处;广东省深圳市宝安区人民医院麻醉科;
【基金】：吴阶平自然基金项目(32067501337) 黑龙江省牡丹江市科委基金项目(Z2014s082) 牡丹江医学院院级科研项目(20150527)
【分类号】：R614

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