hs-CRPI、L-6与老年人七氟烷吸入麻醉术后认知功能关系的研究

Relationship between hs-CRP,IL-6 and the cognitive function decrease of elderly after sevoflurane anesthesia

目的:探讨hs-CRPI、L-6与老年人七氟烷吸入麻醉术后认知功能下降的关系。方法:选取行上腹部手术的患者40例,年龄65岁～79岁,麻醉诱导和维持均采用七氟烷吸入,术中调节七氟烷浓度以确保合适的麻醉深度。均于术前、术后1 d7、d由同一试验者采用MMSE评价认知功能,术后1 d的MMSE评分较术前下降且超过2分的患者纳入认知功能下降组,其余患者纳入正常组。并测Hs-CRPI、L-6的浓度进行比较。结果:两组患者一般情况比较均无统计学意义(P>0.05)。全组病例MMSE评分均大于23分,未见认知功能损害者。与正常组比较,下降组患者术后1 d的MMSE评分低(t=4.468,P=0.000)。与正常组比较,下降组患者术后1 d的Hs-CRPI、L-6高(t=-3.641,P=0.002t、=-2.234,P=0.037)。两组患者术前、术后7 d的MMSE评分与Hs-CRPI、L-6比较均无统计学意义(P>0.05)。下降组患者术后1 d的MMSE评分与术后1 d的Hs-CRPI、L-6呈负相关(r=-0.831,P=0.001r、=-0.890,P=0.000),术后1 d的Hs-CRP与术后1 d的IL-6呈正相关(r=0.705,P=0.011)。结论:hs-CRPI、L-6的升高与老年人七氟烷吸入麻醉术后认知功能下降的关系密切,Hs-CRP相比于IL-6是预测和诊治老年患者认知功能同样有效但更简单的检验指标。

Objective：To discuss the relationship between hs-CRP,IL-6 and the cognitive function decrease of elderly after sevoflurane anesthesia.Methods： 40 patients undergoing upper abdominal surgery aged 65~79 were induced and maintained with suitable sevoflurane concentration to keep appropriate depth of anesthesia.The cognitive function with MMSE assessment of the same patient before surgery and 1 d,7 d after surgery were evaluated.The patients whose MMSE score 1d after surgery decreased more than 2 scores compared with the preoperative patients came into the cognitive decline group,the others were included in the normal group.Meanwhile The concentration of Hs-CRP and IL-6 were measured and compared.Results： Compared the two groups,there were generally not statistically significant differences（P〈0.05）.MMSE score of all the patients were higher than 23 points,with no cognitive dysfunction found.Compared with the normal group,MMSE score of the decline group was lower（t=4.468,P=0.000）,and Hs-CRP,IL-6 1d after surgery were higher（t=-3.641,P=0.002,t=-2.234,P=0.037）.Before and 7d after surgery,the MMSE score and concentration of Hs-CRP,IL-6 of the two groups had no statistical significance（P〈0.05）.The MMSE score and Hs-CRP,IL-6 concentration of the decline group 1d after surgery was negatively correlated（r=-0.831,P=0.001,r=-0.890,P=0.000）,while the Hs-CRP concentration 1d after surgery was positively correlated with the IL-6 concentration 1d after surgery（r=0.705,P=0.011）.Conclusion： Level increase of hs-CRP and IL-6 had a close relationship with the elderly cognitive function decline after sevoflurane anesthesia.Compared to the IL-6,Hs-CRP was the same effective but with much more simple test indicators to predict and diagnose the elderly cognitive function.