【摘要】 目的研究七氟烷静吸复合右美托咪定麻醉对老年腹腔镜肿瘤切除术后认知功能及血清神经生长因子(NGF)、脑源性神经营养因子(BDNF)水平的影响,为临床研究提供指导。方法选取深圳市人民医院于2018年9月至2020年9月收治的80例行腹腔镜肿瘤切除术的老年患者进行研究,按照随机数表法分为观察组和对照组各40例。对照组行七氟烷静吸麻醉,观察组行七氟烷静吸复合右美托咪定麻醉。比较两组患者麻醉前10 min(T0)、麻醉后10 min (T1)、手术中(T2)、手术后(T3)的心率和血氧饱和度,术中血压水平、出血量,术后苏醒时间、说话时间以及拔管时间,麻醉前、术后1 d、3 d、5 d的简易智力状态检查量表(MMSE)评分和连线试验(TMT)完成时间情况,以及麻醉前、术后血清BDNF、NGF水平变化情况。结果两组患者的心率、血氧饱和度在T1、T2时均较T0时明显升高,对照组心率、血氧饱和度在T1、T2时分别为(107.68±4.57)次/min、(98.45±0.39)%、(97.59±5.25)次/min、(98.01±0.39)%,明显高于观察组的(102.09±4.69)次/min、(97.26±0.30)%、(92.18±3.92)次/min、(96.73±0.34)%,差异均具有统计学意义(P<0.05);观察组患者术中收缩压、舒张压、术中出血量分别为(120.21±10.40) mmHg、(78.12±9.95) mmHg、(226.15±8.12) m L,明显低于对照组的(126.42±10.21) mmHg、(83.26±9.11) mmHg、(234.51±8.74) mL,苏醒时间、说话时间、拔管时间分别为(40.52±2.52) min、(110.17±12.10) min、(90.47±12.51) min,明显短于对照组的(46.77±2.13) min、(115.42±12.28) min、(99.56±12.12) min,差异均有统计学意义(P<0.05);术后1 d、3 d,两组患者的TMT完成时间较麻醉前延长,对照组分别为(46.16±3.05) s、(44.84±2.64) s,明显长于观察组的(44.32±2.68) s、(43.38±2.78) s,差异均有统计学意义(P<0.05);术后1 d、3 d,两组患者的MMSE评分较麻醉前降低,对照组分别为(24.92±1.69)分、(25.46±1.56)分,明显低于观察组的(25.91±1.37)分、(26.56±1.36)分,差异均具有统计学意义(P<0.05);术后,观察组患者的血清BDNF、NGF水平分别为(23.62±5.48) pg/mL、(29.76±3.33) pg/mL,均明显低于麻醉前的(24.31±5.51) pg/mL、(28.92±1.79) pg/mL,对照组患者的血清BDNF、NGF水平分别为(24.31±5.51) pg/mL、(28.92±1.79) pg/mL,均明显低于麻醉前的(29.22±5.43) pg/mL、(32.60±1.94) pg/mL,差异均有统计学意义(P<0.05),但观察组和对照组比较差异均无统计学意义(P>0.05)。结论七氟烷静吸复合右美托咪定麻醉应用于老年腹腔镜肿瘤切除术对患者的血流动力学影响较小,且可降低血清中NGF、BDNF含量,促进患者术后认知功能恢复。更多还原

【Abstract】 Objective To study the effect of sevoflurane inhalation combined with dexmedetomidine anesthesia on cognitive function and serum nerve growth factor(NGF), brain-derived neurotrophic factor(BDNF) levels after laparoscopic tumor resection in elderly patients, in order to provide guidance for clinical research. Methods A total of80 elderly patients undergoing laparoscopic tumor resection from September 2018 to September 2020 in Department of Anesthesiology, Shenzhen People’s Hospital were selected and divided into the observation group and control group according to random number table method, with 40 patients in each group. The control group was anesthetized with sevoflurane, and the observation group was anesthetized with sevoflurane combined with dexmedetomidine. The heart rate and blood oxygen saturation of the two groups of patients 10 min before anesthesia(T0), 10 min after anesthesia(T1),during the operation(T2), and after the operation(T3), intraoperative blood pressure level, blood loss, postoperative recovery time, speech time and extubation time, Mini-Mental State Examination(MMSE) score and Trail Making Test(TMT) completion time before anesthesia and 1 d, 3 d, 5 d after anesthesia, and changes in serum BDNF and NGF levels before and after anesthesia were observed and compared. Results The heart rate and blood oxygen saturation of the two groups were significantly higher at T1 and T2 than at T0, and the heart rate and blood oxygen saturation of the control group were(107.68±4.57) beats/min and(98.45±0.39)%,(97.59±5.25) times/min and(98.01±0.39)%, which were significantly higher than corresponding(102.09 ± 4.69) times/min and(97.26 ± 0.30)%,(92.18 ± 3.92) times/min and(96.73 ± 0.34)% in the observation group(P<0.05); the intraoperative systolic blood pressure, diastolic blood pressure,and intraoperative blood loss in the observation group were(120.21±10.40) mmHg,(78.12±9.95) mmHg, and(226.15±8.12) mL, which were significantly lower than corresponding(126.42±10.21) mmHg,(83.26±9.11) mmHg, and(234.51±8.74) mL of the control group, and the wake-up time, speaking time, and extubation time were(40.52 ± 2.52) min,(110.17±12.10) min,(90.47±12.51) min, which were significantly shorter than corresponding(46.77±2.13) min,(115.42±12.28) min,(99.56±12.12) min in the control group(all P<0.05); at 1 and 3 days after operation, the completion time of TMT in the two groups were longer than that before anesthesia, the time in the control group were(46.16±3.05) s and(44.84 ± 2.64) s, which were significantly longer than the observation group’s(44.32 ± 2.68) s and(43.38 ± 2.78) s(P<0.05); at 1 and 3 days after operation, the MMSE scores of the two groups were lower than those before anesthesia, the scores in the control group were(24.92±1.69) points and(25.46±1.56) points, which were significantly lower than corresponding(25.91 ± 1.37) points and(26.56 ± 1.36) points in the observation group(P<0.05); after operation, the serum BDNF and NGF levels of the observation group were(23.62±5.48) pg/mL and(29.76±3.33) pg/mL, which were significantly lower than corresponding(24.31±5.51) pg/mL and(28.92±1.79) pg/mL before anesthesia; the serum BDNF and NGF levels of patients in the control group were(24.31±5.51) pg/mL and(28.92±1.79) pg/mL, which were significantly lower than corresponding(29.22±5.43) pg/mL and(32.60±1.94) pg/mL before anesthesia(P<0.05), but the difference between the observation group and the control group was not statistically significant(P>0.05). Conclusion Sevoflurane intravenous inhalation combined with dexmedetomidine anesthesia used in elderly laparoscopic tumor resection have little effect on the hemodynamics of patients, and can reduce the serum levels of NGF and BDNF, and promote the recovery of postoperative cognitive function.更多还原