加速康复外科策略对肝切除术患者术后早期认知功能的影响

发布时间：2018-01-26 18:05

本文关键词： 加速康复外科肝切除术术后认知功能　出处：《临床麻醉学杂志》2016年07期 　论文类型：期刊论文

【摘要】：目的探讨加速康复外科(ERAS)策略对肝切除术患者术后早期认知功能的影响。方法筛选96例原发性肝癌择期行肝部分切除术患者,随机分为两组,每组48例。C组实施常规围术期处理及麻醉方法,ERAS组实施ERAS策略对围术期处理及麻醉方法进行优化。于术前1d(T0)、术后1d(T4)、3d(T5)、7d(T6)应用简易智能量表(MMSE)评估两组患者认知功能,于T0、术后30min(T1)、6h(T2)、12h(T3)、T4取患者静脉血检测血清S100β蛋白、神经元特异性烯醇化酶(NSE)含量和IL-1β、IL-6及TNF-α表达量。结果与C组比较,T4、T5时ERAS组MMSE评分明显升高,T1、T2时S100β蛋白、IL-1β、IL-6明显降低,T2、T3时NSE明显降低,T1~T3时TNF-α明显降低(P0.05)。与T0时比较,T4、T5时C组患者MMSE评分明显降低,T4时ERAS组MMSE评分明显降低(P0.05)。两组T1~T3时S100β蛋白明显升高,T2~T4时NSE含量明显升高,T1~T4时IL-1β、IL-6、TNF-α表达量均明显升高(P0.05)。结论 ERAS策略应用于肝癌肝切除术患者可改善患者术后认知功能,其机制可能与降低患者术后血清中S100β蛋白、NSE、IL-1β、IL-6及TNF-α的含量有关。
[Abstract]:Objective to investigate the effect of accelerated rehabilitation surgery (ERASS) strategy on early cognitive function after hepatectomy. Methods 96 patients with primary liver cancer undergoing selective partial hepatectomy were randomly divided into two groups. Each group (n = 48) received routine perioperative management and anesthesia was performed with ERAS strategy in group ERAS. The perioperative management and anesthesia methods were optimized 1 day before operation. MMSE was used to evaluate the cognitive function of the two groups at T0 and 30 min after operation. Serum S100 尾 protein, neuron-specific enolase (NSE) content and IL-1 尾 were measured by 12 h T3 + T4. Results compared with group C, the MMSE score of ERAS group was significantly higher than that of group C at T _ 1 T _ 2 and T _ 1 / T _ 2. Results compared with group C, the MMSE score of ERAS group was significantly higher than that of group C at T _ 1 and T _ 2. IL-6 significantly decreased T _ 2T _ 3, NSE significantly decreased T _ 1 and T _ 3, TNF- 伪 significantly decreased P _ (0.05), compared with T _ (0) T _ (4). The MMSE score of group C was significantly lower than that of group C at T 5. The MMSE score of group ERAS was significantly lower than that of group ERAS at T 4. The S100 尾 protein increased significantly at T 1 and T 3 in both groups. The content of NSE increased significantly at T2T4 and IL-1 尾 -IL-6 at T1T4. The expression of TNF- 伪 was significantly increased (P 0.05). Conclusion ERAS strategy can improve postoperative cognitive function in patients with liver cancer after hepatectomy. The mechanism may be related to the decrease of serum S100 尾 protein, IL-1 尾, IL-6 and TNF- 伪 levels.
【作者单位】：南昌大学第二附属医院麻醉科;
【基金】：国家自然科学基金(81560193)
【分类号】：R614
【正文快照】： 术后认知功能障碍(POCD)是常见的麻醉并发症之一,肝癌患者具有其自身的特殊性,在肝切除术后患者的POCD发生率可能更高[1,2],主要表现为精神错乱、焦虑、人格的改变以及记忆受损,同时伴有社交能力及认知能力的改变,严重影响治疗效果和患者的术后生活质量[3]。加速康复外科(ERAS

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