不同麻醉方式对老年直肠癌根治术患者S100β蛋白和认知功能障碍的影响

Influence of different anesthesia modes on S100β protein and cognitive dysfunction in elderly patients with rectal cancer radical operation

目的分析对老年直肠癌根治术患者采用不同麻醉方法对认知功能障碍(POCD)及S100β蛋白的影响。方法对该院2015年1月至2016年1月收治的100例采用直肠癌根治术治疗的直肠癌患者进行观察,ASAⅠ~Ⅲ级。采用随机分组法分为研究组和参照组,随机分组法经过医院伦理委员会通过。研究组采用全身麻醉联合硬膜外麻醉,参照组单独采用全身麻醉。两组患者麻醉诱导药物相同,分别在麻醉诱导前(T1)、术中2 h(T2)、术后24 h(T3)、术后72 h(T4)采集患者静脉血进行S100β蛋白含量测定,并用简易精神状态评价量表(MMSE)评分对患者的POCD发生率进行评估,观察检测结果。同时,记录两组患者麻醉时间、苏醒期躁动次数、苏醒时间、拔管时间、麻醉期间的麻黄碱用量情况。结果两组患者在T2时的POCD发生率、S100β蛋白浓度均较高,但研究组术中及术后的POCD发生率、S100β蛋白浓度均低于参照组,差异均有统计学意义(P<0.05)。研究组麻醉时间明显长于参照组麻醉时间,研究组苏醒期躁动次数、苏醒时间、拔管时间、麻醉期间的麻黄碱用量均大于参照组,差异均有统计学意义(P<0.05)。结论全身麻醉联合硬膜外麻醉的麻醉效果好,安全性高,虽延长了麻醉时间,但缩短了麻醉苏醒时间,可以降低POCD、苏醒期躁动发生率。S100β蛋白反映中枢神经损伤程度,对评估POCD发生率有重要作用。

Objective To analyze the influence of different anesthesia methods on S100β protein and postoperative cognitive dysfunction（POCD） in eolderly patients with rectal cancer radical operation. Methods One hundred ASA grade Ⅰ-Ⅲcases of rectal cancer radical operation in our hospital from Jan. 2015 to Jan. 2016 were observed and divided into the study group and reference group by using the random grouping method. The random grouping method was passed by the hospital ethics com-mittee. The study group used general anesthesia combined with epidural anaesthesia,while the reference group used general anesthesia alone. The anesthesia induction drugs were same in the two groups. Venous blood in the two groups was collected before anesthesia induction（T1）,at intraoperativeoperation 2 h（T2）,at postoperative 24 h（T3） and 72 h（T4） for testing S100β proteint level. The POCD occurrence rate was evaluated by using the MMSE score and the resuts were observed. At the same time,the anesthesia time,restlessness times during recovery stage,recovery time,extubation time and dosage of ephedrine during anesthesia period were recorded in the two groups. Results The POCD occurrence rate and S100β protein at T2 in the two groups were higher,but which during operation and after operation in the study group were lower than those in the reference group,the difference was statistically significant（P〈0.05）. The anesthesia time in the study group was significantly longer than that in the reference group,the agitation times,recovery time,extubation time and dose of ephedrine during anesthesia period in the research group were more than those in the reference group,the difference was statistically significant（P〈0.05）. Conclusion General anesthesia combined with epidural anaesthesia has good anesthetic effect and high safety,prolongs anesthesia time,shortens the recovery time of anesthesia,can reduce the occurrence rates of POCD and restlessness during recovery period. S100β protein reflects the degree of central nervous system damage,and play an important role in assessing the incidence of POCD.