七氟醚对肝脏缺血再灌注损伤所致术后认知功能变化的影响

Effect of sevoflurane on postoperative cognitive function in patients with hepatic ischemia reperfusion injury

目的观察七氟醚静吸复合麻醉对肝脏部分切除术患者肝脏缺血再灌注损伤所致术后认知功能变化的影响。方法择期行肝脏部分切除术的肝脏肿瘤患者40例,随机分为两组(n=20):实验组和对照组,两组患者手术方式一致。于术前、术后1、3、7 d分别监测患者外周血肝功能指标谷丙转氨酶(ALT)、谷草转氨酶(AST);于术前1 d、术后7 d行神经心理学组合测试,根据Z值计算公式,计算患者术后认知功能障碍(POCD)的发生率。结果与术前比较,患者血清ALT、AST术后明显升高,实验组术后1、3、7 d显著低于对照组(P<0.05);与对照组比较,实验组Hopkins言语学习测试、循迹连线测试A、循迹连线测试B、词语延迟记忆术前与术后成绩差值明显升高(P<0.05),实验组和对照组POCD的发生率分别为10%和30%,对照组POCD的发生率明显高于实验组(P<0.05)。结论七氟醚静吸复合麻醉可以减轻肝脏部分切除术后患者的缺血再灌注损伤,减少POCD的发生。

Objective To investigate the effect of anesthesia combined with sevoflurane inhalation on postoperative cognitive function in patients undergoing partial hepatectomy with hepatic ischemia-reperfusion. Methods Forty patients with hepatic tumor, scheduled for partial hepatectomy were randomly divided into two groups （n = 20） ： the control group and the experience group, the manner of operation between different groups kept constant. Blood sample was taken from the peripheral vein on the lth day before surgery and lth ,3th ,7th days after surgery for determi- nation of alanine aminotransferase （ALT）, aspartate transaminase （AST）. Neuropsychological tests were performed at the lth day before surgery and the 7th day after surgery. The incidence of postoperative cognitive dysfunction （POCD） was calculated in two groups. Results Compared with preoperation, the levels of serum ALT and AST were significantly increased after surgery in two groups, at the 1 th,3th,7th days after surgery, the levels in experi- ence group was significantly lower than those of control group （ P 〈 0. 05 ） ; Compared with control group, the differences between preoperative and postoperative values of Hopkins Verbal Learning Test - Revised, trail marking test A, trail marking test B and word delayed memory were significantly higher than those of experience group, and the incidence of postoperative cognitive dysfunction was decreased （P 〈 0. 05 ）. Conclusion Sevoflurane inhalation with anesthesia can alleviate the ischemia-repeffusion injury and reduce the occurrence of POCD after partial hepatectomy.