胃癌患者内镜黏膜下剥离术中丙泊酚麻醉的疗效及对早期认知功能的改善效果

Efficacy of Propofol Anesthesia for Gastric Cancer Treated with Endoscopic Submucosal Dissection and the Influence on Cognitive Function

目的观察丙泊酚麻醉在胃癌患者内镜黏膜下剥离术中的疗效及对认知功能的影响。方法选择胃癌患者90例,根据不同麻醉方法随机分为对照组(45例)和研究组(45例)。对照组患者给予芬太尼联合维库溴铵麻醉,在对照组基础上研究组加用持续泵入丙泊酚。对两组患者行内镜黏膜下剥离术(ESD)。比较两组手术时间、术中出血量、住院时间、Ransay评分和视觉模拟疼痛评分(VAS)。检测两组血清中S100β蛋白水平。结果研究组患者的手术时间、术中出血量及住院时间明显优于对照组(P<0.01)。术后6 d,两组患者的Ransay和VAS评分比较差异有统计学意义(P>0.05)。术后3 d,对照组患者的MMSE评分显著低于研究组(P<0.01)。研究组术后3 d认知障碍发生2例,明显少于对照组,差异有统计学意义(P<0.05)。研究组术后1 h和6 h血清中S100β蛋白水平分别低于对照组同期(P<0.01)。结论胃癌内镜黏膜下剥离术中使用丙泊酚麻醉对患者的认知功能起到保护作用,下调血清中S100β蛋白水平可能与之有关。

Objective To observe efficacy of propofol anesthesia for gastric cancer treated with endoscopic submucosal dissection（ESD） and the influence on cognitive function. Methods 90 patients with gastric cancer were randomly divided into the control group（45 cases）and the research group（45 cases）according to different anesthesia methods. The control group was given anesthesia with fentanyl and vecuronium bromide. Based on the control group, the research group was given intravenously continuous pumping of propofol. All patients received ESD. Time of operation, intraoperative blood loss, hospital stays, and scores of Ransay and visual analog pain scale（VAS） were compared in both groups. Serum level of S100β protein was detected in both groups. Results Time of operation, intraoperative blood loss, and hospital stay of the research group were obviously lower than the control group（P 〈0.01 ）. 6 days after of operation,scores of Ransay and VAS had no statistical difference between the 2 groups （ P 〉 0.05 ）. 3 days after operation, MMSE score and occurrence rate of cognitive disorder of the observation group was remarkably lower than those of the control group（P 〈0.01 ,P 〈0.05）. 1 h and 6 h after operation,serum level of S100β protein in the re- search group was lower than the control group （P 〈 0.01 ）. Conclusion Effect of propofol anesthesia for gastric cancer treated with ESD can protect cognitive function ,and may be related to decrease of S100βserum level .