瑞芬太尼复合丙泊酚全凭静脉麻醉对老年骨科手术患者术后认知功能及炎症因子的影响

Effects of total intravenous anesthesia with remifentanil plus propofol on postoperative cognitive function and inflammatory factors in elderly patients undergoing orthopedic surgery

目的探讨瑞芬太尼复合丙泊酚全凭静脉麻醉对老年骨科手术患者术后认知功能及炎症因子水平的影响。方法将80例择期行骨科手术的老年患者随机分为对照组38例和研究组42例。对照组采用芬太尼复合丙泊酚进行全凭静脉麻醉,研究组采用瑞芬太尼复合丙泊酚进行全凭静脉麻醉。比较两组患者手术前后的简易精神状态量表(MMSE)评分、术后认知障碍(POCD)发生情况及高敏C-反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)的变化情况。结果两组术后24h的hs-CRP、IL-6及TNF-α水平均高于术前,但研究组的hs-CRP、IL-6、TNF-α水平低于对照组(P<0.05)。两组患者MMSE评分比较,差异有统计学差异(P<0.05),两组MMSE评分均呈现出随时间变化的趋势(P<0.05),分组与时间有交互效用(P<0.05)。研究组术后3 h、6 h、24 h POCD的发生率低于对照组(P<0.05),而两组术后48及72 hPOCD的发生率比较,差异无统计学意义(P>0.05)。结论在老年患者骨科手术中采用瑞芬太尼复合丙泊酚进行全凭静脉麻醉,可降低患者术后IL-6、TNF-α、hs-CPR水平,减少POCD的发生。

Objective To investigate the effects of total intravenous anesthesia with remifentanil plus propofol on the postoperative cognitive function and inflammatory factors in elderly patients undergoing orthopedic surgery. Methods Eighty elderly patients undergoing elective orthopedic surgery were randomly divided into control group（38 cases） and study group（42 cases）. The control group received fentanyl combined with propofol for total intravenous anesthesia,and the study group received remifentanil combined with propofol for total intravenous anesthesia. The preoperative and postoperative Mini-Mental State Examination（MMSE） scores,the incidence of postoperative cognitive dysfunction（POCD）,and the changes of high-sensitivity C-reactive protein（hs-CRP）,interleukin-6（IL-6） and tumor necrosis factor alpha（TNF-α） were compared between the two groups. Results After 24 hours of operation,the levels of hs-CRP,IL-6 and TNF-α in the two groups were higher than those before operation,but the levels of hs-CRP,IL-6 and TNF-α in the study group were lower than those in the control group（P〈0. 05）. There were significant differences in MMSE scores between the two groups（P〈0. 05）,the changes of MMSE scores presented a time-dependent trend in both groups（P〈0. 05）,and the interactive effects was observed between group and time（P〈0. 05）. The postoperative 3-,6-,24-hour incidence rates of POCD in the study group were lower than those in the control group（P〈0. 05）,but there was no significant difference between the two groups in the postoperative 48-or 72-hour incidence rate of POCD（P〈0. 05）. Conclusion Remifentanil combined with propofol for total intravenous anesthesia can reduce the levels of postoperative IL-6,TNF-α and hs-CPR as well as the incidence of POCD in elderly patients undergoing orthopedic surgery.