【摘要】 目的探讨围术期静脉注射血必净注射液对老年食管癌患者术后认知功能的影响。方法选择2017年1月—2020年4月在揭阳市人民医院择期行胸腹腔镜联合食管癌根治术老年患者80例,采用随机数字表法将患者分为实验组和对照组,每组40例。实验组患者在术前1 d、手术当天及术后1～3 d静脉滴注血必净注射液50 mL+生理盐水100 mL,30 min内滴注完毕,对照组在同一时间段静脉滴注等量生理盐水。2组患者均采用硬膜外麻醉复合支气管插管静脉全身麻醉,术后行硬膜外自控镇痛。分别于术前1 d及术后1 d、3 d、7 d使用简易精神状态量表(MMSE)评估2组患者认知功能情况,采用ELISA法测定2组患者血清白细胞介素-6(IL-6)、肿瘤坏死因子(TNF-α)、S100β蛋白水平,记录2组术后认知功能障碍发生率。结果 2组术前1 d及术后7 d的MMSE评分比较差异均无统计学意义(P均>0.05),实验组患者术后1 d、3 d的MMSE评分均明显高于对照组(P均<0.05);2组患者术前1 d的血清IL-6、TNF-α、S100β蛋白水平比较差异均无统计学意义(P均>0.05),实验组患者术后1 d、3 d、7 d的血清IL-6、TNF-α、S100β蛋白水平均明显低于对照组(P均<0.05);实验组术后认知功能障碍发生率为7.5%(3/40),对照组为25.0%(10/40),实验组明显低于对照组(P<0.05)。结论围术期静脉注射血必净注射液能一定程度预防老年食管癌患者术后认知功能障碍的发生,可降低S100β蛋白水平,机制可能与抑制IL-6、TNF-α的产生及释放,减轻炎症损伤有关。更多还原

【Abstract】 Objective It is to explore the effect of perioperative intravenous injection of Xuebijing injection on postoperative cognitive function in elderly patients with esophageal cancer. Methods Eighty elderly patients undergoing thoracic laparoscopy combined with radical esophageal cancer surgery at Jieyang People’s Hospital from January 2017 to April 2020 were selected, ASA classification II to III, 65-80 years old, and body mass index 18-25 kg/m~2, the patients were divided into experimental group and control group by random number table method, 40 cases in each group. The patients in the experimental group were intravenously infused with Xuebijing injection 50 mL+normal saline 100 mL 1 day before surgery, on the day of surgery, and 1～3 days after surgery. The infusion was completed within 30 minutes. The control group received the same amount of normal saline at the same time period. The patients in both groups were treated with epidural anesthesia combined with bronchial intubation and intravenous general anesthesia, and given patient-controlled epidural analgesia after surgery. The cognitive function of patients in the 2 groups was assessed by the Mini Mental State Scale(MMSE) on the 1 d before operation and 1 d, 3 d, 7 d after the operation, and the levels of serum interleukin-6(IL-6), tumor necrosis factor(TNF-α) and S100β protein of the 2 groups were measured by the ELISA method, and the incidence of postoperative cognitive dysfunction in the two groups was recorded. Results There was no significant difference in the MMSE scores between the two groups on the 1 st day before and 7 days after the operation(all P>0.05). The MMSE scores of the experimental group were significantly higher than those of the control group on the 1 st and 3 rd day after surgery(all P<0.05). There was no significant difference in the levels of serum IL-6, TNF-α, and S100β protein of the patients 1 d before operation between the two groups(P>0.05), the levels of serum IL-6, TNF-α, and S100β protein of patients in the experimental group were significantly lower than those in the control group at 1 d, 3 d, and 7 d after surgery(all P<0.05); the incidence of postoperative cognitive dysfunction in the experimental group was 7.5%(3/40), that was 25.0%(10/40) in the control group, and the experimental group was significantly lower than the control group(P<0.05). Conclusion Perioperative intravenous injection of Xuebijing injection can prevent the occurrence of postoperative cognitive dysfunction in elderly patients with esophageal cancer to a certain extent, and can reduce the level of S100β protein. The mechanism may be related to inhibiting the production and release of IL-6 and TNF-α, and relieving inflammation damage.更多还原