老年腹腔镜全麻手术患者术后中药方剂应用对患者认知功能及BDNF-TrkB通路的影响

Effects of postoperative traditional Chinese medicine prescription application on cognitive function and BDNF-TrkB pathway in elderly patients undergoing laparoscopic general anesthesia

目的:探讨分析老年腹腔镜全麻手术患者术后中药方剂应用对患者认知功能及BDNF-TrkB通路的影响。方法:选择2019年3月~2022年3月在衡水市第四人民医院行腹腔镜全身麻醉手术的老年患者125例,将患者随机分为观察组64例、对照组61例,两组患者均采取腹腔镜全麻手术,对照组患者术后常规观察、治疗,观察组在对照组基础上术后给予健脾益髓汤。比较两组患者手术前后认知功能简易智力状态检查量表(MMSE)、血清炎症因子及S100β蛋白水平、BDNF-TrkB通路表达情况,并比较两组患者术后认知功能障碍(POCD)发生率。结果:两组患者术后3d MMSE评分均较术前降低(P<0.05),术后3d、术后7d观察组患者MMSE评分高于对照组(P<0.05)。两组患者术后3d、术后7d血清炎症因子(IL-6、IL-8、CRP)以及S100β蛋白水平均较术前升高(P<0.05),而术后3d、术后7d观察组患者血清炎症因子以及S100β蛋白水平均低于对照组(P<0.05)。术后3d、术后7d观察组患者血清BDNF、TrkB表达较术前升高(P<0.05),而术后3d、术后7d对照组患者血清BDNF、TrkB表达较术前降低(P<0.05),术后3d、术后7d观察组患者血清BDNF、TrkB表达高于对照组(P<0.05)。术后3d、术后7d观察组患者POCD发生率均低于对照组(P<0.05)。结论:老年腹腔镜全麻患者术后给予健脾益髓方,可有效改善患者术后认知功能,降低术后POCD发生率,其机制可能与抑制患者炎症反应,激活BDNF/TrkB通路有关。

Objective:To investigate and analyze the effect of postoperative traditional Chinese medicine prescription application on cognitive function and BDNF-TrkB pathway in elderly patients undergoing laparoscopic general anesthesia.Methods:A total of 125 elderly patients undergoing laparoscopic general anesthesia surgery in the Fourth People's Hospital of Hengshui from March 2019 to March 2022 were selected and randomly divided into the observation group(64 cases)and the control group(61 cases).Both groups were treated with laparoscopic general anesthesia surgery.The patients in the control group were given routine postoperative observation and treatment,while the patients in the observation group were given Jianpi Yisui Decoction on the basis of the control group.The cognitive function score(MMSE),serum inflammatory factors and S100 were compared between the two groups before and after operationβProtein level,the expression of BDNF-TrkB pathway,and the incidence of postoperative cognitive impairment(POCD)between the two groups were compared.Results:The MMSE scores of the two groups at 3d after operation were significantly lower than those before operation(P<0.05).The MMSE scores of the observation group at 3d and 7d after operation were significantly higher than those in the control group(P<0.05).The levels of serum inflammatory factors(IL-6,IL-8,CRP)and S100βprotein in the two groups were significantly higher than those before operation 3d and 7d after operation(P<0.05).The levels of serum inflammatory factors and S100βprotein in the group were significantly lower than those in the control group(P<0.05).The expressions of serum BDNF and TrkB in the observation group at 3d and 7d after operation were significantly higher than those before operation(P<0.05),while the expressions of serum BDNF and TrkB in the control group at 3d and 7d after operation were significantly lower than those before operation(P<0.05),the expressions of serum BDNF and TrkB in the observation group were significantly higher than those in the control group at 3d and 7d after operation(P<0.05).The incidence of POCD in the observation group at 3d and 7d after operation was significantly lower than that in the control group(P<0.05).Conclusion:The elderly patients with laparoscopic general anesthesia were given Jianpi Yisui Fang after operation,which can effectively improve the postoperative cognitive function and reduce the incidence of postoperative POCD.The mechanism may be related to inhibiting the inflammatory response and activating the BDNF/TrkB pathway.