两种麻醉方式对老年肺癌患者术后认知功能及血清S100β蛋白的影响

Effects of two anesthetic methods on the postoperative cognitive function and serum S100 β protein in elderly patients with lung cancer

目的分析比较硬膜外联合静脉全麻与全身麻醉对老年肺癌患者术后认知功能及血清S100β蛋白的影响。方法以2015年5月—2017年4月在我院进行肺癌手术的108例老年患者为研究对象，随机分为2组，一组实施硬膜外联合静脉全麻，设为观察组，一组实施全身麻醉，设为对照组。对比2组术后情况、不同时点简明精神状态量表（MMSE）得分、不同时点术后认知功能障碍（POCD）比例、不同时点血清S100β蛋白水平。结果观察组术后开始睁眼时间和拔管时间均短于对照组（P〈0．05）。术后6h，2组MMSE得分均明显下降，从术后1天开始，2组MMSE得分均逐渐回升，至术后7天，2组MMSE得分和术前1天的差异均无统计学意义（P〉0．05）；观察组在术后6h、1天和3天的MMSE得分均高于对照组，差异有统计学意义（均P〈0．05）。术后，2组患者均出现认知功能障碍，术后6h比例最高，之后逐渐下降，术后7天，2组均无认知功能障碍患者；观察组在术后6h和术后1天两个时点的POCD比例均低于对照组，差异有统计学意义（均P〈0．05）。术后即刻，2组血清S100β蛋白水平均明显升高，术后12h至术后3天，2组血清s100β蛋白水平均逐渐下降，观察组在术后即刻、术后12h、术后1天及术后3天四个时点的血清S100β蛋白水平均低于对照组，差异有统计学意义（均P〈0．05）。结论硬膜外联合静脉全麻和全身麻醉用于老年肺癌手术患者均会造成认知功能障碍，但硬膜外联合静脉全麻较全身麻醉的影响轻，可降低认知功能障碍发生率。

Objective To analyze the effects of two anesthetic methods on the postoperative cognitive function and serum S100β protein in elderly patients with lung cancer. Methods A total of 108 elderly patients who underwent lung cancer surgery in hospital from May 2015 to April 2017 were enrolled in the current study. They were randomly divided into two groups： an observation group receiving epidural combined with intravenous general anesthesia and a control group under general anesthesia. Both groups were compared for postoperative condition and the mini - mental state examination （MMSE） scores, postoperative cognitive dysfunction （POCD） ratio, and serum S100β protein levels at different time points. Results The observation group showed shorter eye opening time and extubation time than the control group （P 〈 0. 05）. Then, 6 h after operation, remarkable decreased MMSE scores were found in both groups. The MMSE scores of both groups were gradually increased since one day after surgery, and no statistical difference was found in the score be- tween seven days after surgery and one day before surgery （P 〉 0.05 ）. Compared with the control, the observation group produced marked higher MMSE scores 6 hours, 1 and 3 days after surgery （ P 〈 0.05）. Postoperative cognitive dysfunc- tion occurred in the two groups. The cognitive dysfunction incidence was highest 6 hours after surgery, and then gradually reduced. No cognitive impairment was in the two groups 7 days after surgery. Compared with the control, the percentage of POCD was lower in the observation group 6 hours and 1 day after surgery （ each P 〈 0.05）. The level of serum S100β protein was significantly increased immediately after surgery in the two groups, which was then gradually reduced 12 hour and 3 days after surgery. Compared with the control, the levels of serum S100β protein was remarkably decreased in theobservation group immediately, 12 hours, 1 and 3 days after surgery （ each P 〈 0.05 ）. Conclusions Epidural com- bined with intravenous general anesthesia and general anesthesia can cause cognitive impairment in elderly patients with lung cancer surgery, but epidural combined with intravenous general anesthesia is less sensitive than general anesthesia and can reduce the incidence of cognitive impairment.