依托咪酯麻醉诱导对老年患者腹部手术后炎性细胞因子和术后早期认知功能的影响

Effect of intravenous injection of etomidate on cytokines and postoperative cognitive function after abdominal surgery in elderly patients

目的探讨依托咪酯诱导对老年患者腹部手术后炎性细胞因子和早期认知功能的影响。方法选择美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级、择期行腹部手术的老年患者(≥60岁)40例,随机分入丙泊酚组和依托咪酯组,每组20例。丙泊酚组和依托咪酯组分别以丙泊酚1.5mg/kg、依托咪酯0.3mg/kg静脉注射行麻醉诱导,记录麻醉诱导前和麻醉诱导后患者的平均动脉压(MAP)和心率(HR)。分别于麻醉诱导前、手术结束即刻和术后2、24h时,采用固相夹心法ELISA测定患者的血清IL-6、IL-10、TNF-α水平。分别于术前1d和术后1d采用简易精神状态量表(MMSE)进行认知功能评分,并观察术后认知功能障碍(POCD)的发生情况。结果丙泊酚组麻醉诱导后的MAP和HR均显著低于同组麻醉诱导前(P值均<0.05),依托咪酯组麻醉诱导前后MAP和HR的差异均无统计学意义(P值均>0.05);丙泊酚组麻醉诱导后的MAP和HR均显著低于依托咪酯组同时间(P值均<0.05)。丙泊酚组和依托咪酯组手术结束即刻、术后2h、术后24h的血清IL-6、IL-10和TNF-α水平均显著高于同组麻醉诱导前(P值均<0.05)。两组间各时间点的血清IL-6、IL-10、TNF-α水平的差异均无统计学意义(P值均>0.05)。丙泊酚组术前1d和术后1d的MMSE评分分别为(27.55±1.70)和(26.55±2.42)分,依托咪酯组分别为(27.05±1.67)和(25.80±2.55)分。两组术后1d的MMSE评分均显著低于同组术前1d(P值均<0.05),两组间术前1d和术后1d的MMSE评分的差异均无统计学意义(P值均>0.05)。丙泊酚组、依托咪酯组的POCD发生率分别为8/20、9/20,两组间差异无统计学意义(P>0.05)。结论与丙泊酚相比,依托咪酯麻醉诱导应用于老年腹部手术患者,对循环影响轻微,不会增加术后炎性细胞因子的释放和增高POCD发生率。

Objective To evaluate the effect of etomidate used in anesthesia induction on cytokines and postoperative cognitive dysfunction （POCD） after abdominal surgery in elderly patients. Methods Forty patients, American Society Anesthesiologists （ASA） grade Ⅰ or Ⅱ, aged≥60 years old, undergoing elective abdominal surgery were randomly divided into etomidate group and propofol group （n = 20）. Anesthesia was induced with etomidate 0. 3 mg/kg and propofol 1. 5 mg/kg by intravenous injection in the two groups, respectively. The mean arterial pressure（MAP） and heart rate（HR） were recorded before and after induction of anesthesia. The concentrations of serum interleukin 6 （IL-6）, interleukin 10 （IL-10） and tumor necrosis factor-α （TNF-α） were measured by enzyme linked immunosorbent assay（ELISA） before anesthesia, immediately after surgery, 2 and 24 h after surgery. Mine-Mental State Examination （MMSE） scale was used to evaluate cognitive function on day 1 before and after surgery. Results In the propofol group, both MAP and HR after induction were significantly lower than those before induction （both P〈0.05）. However, MAP and HR after induction were not significantly different from those before inductior~ in the etomidate group （both P〈0.05）. The MAP and HR in the propofol group after induction were significantly lower than those in the etomidate group （both P 〈 0. 05）. Compared with those before the induction of anesthesia, the concentrations of IL-6, IL-10 and TNF-α in both groups were significantly increased at the end of surgery, 2 and 24 h after surgery （all P〈0. 05）. There were no significant differences in the IL-6, IL-10 or TNF-α between two groups at each time point （all P〈0.05）. MMSE score in the propofol group on day 1 before and after surgery was 27.55± 1.70 and 26.55 ± 2.42, respectively; and the score was 27.05 ± 1.67 and 25.80 ± 2.55 in the etomidate group. Compared with that on day 1 before surgery, MMSE score was significantly decreased on day 1 after surgery in both groups （both P〈0.05）. But MMSE score on day 1 before surgery was not significantly different from that on day 1 after surgery in both groups （both P〉0.05）. The incidence of POCD was 9/20 in the tomidate group and 8/20 in the propofol group （both P〉0.05）. Conclusion Compared with propofol, etomidate has less influence on MAP and HR and cannot increase the release of cytokines and the incidence of POCD when it is used in the induction of anesthesia in elderly patients undergoing abdominal surgery.