舒芬太尼预处理对老年患者联合麻醉下行髋关节手术术后认知功能的影响

Effect of Sufentanil pretreatment on the postoperative cognitive function in elderly patients undergoing articulation coxae surgery with combined anesthesia

目的:探究舒芬太尼对患者术后认知功能障碍(Postoperative cognitive dysfunction,POCD)的影响及其可能机制。方法:选择ASAⅡ-Ⅲ级于腰硬联合麻醉下行择期髋关节手术患者72例,随机分为低剂量组(L组,21例)、高剂量组(H组,22例)和对照组(C组,29例)。每组患者分别给予舒芬太尼0. 05μg/kg、0. 1μg/kg、0. 9%盐水2 mL,分别于术前、手术结束时测量血清中IL-1β、TNF-α,术前1 d,出手术室时,术后1 d、3 d、7 d,采用简易智能状态检查量表法(MMSE量表)评估认知功能。结果:与术前比较,3组患者出手术室时、术后1 d、3 d、7 d与术前1 d比较,MMSE评分均降低(P <0. 05),H组患者出手术室时、术后1 d、3 d、7 d患者术后POCD发生率均低于C组及L组(P <0. 05)。3组患者术后IL-1β、TNF-α与术前比较均升高(P <0. 05),H组患者术后IL-1β、TNF-α均低于C组及L组(P <0. 05)。结论:舒芬太尼可降低POCD的发生率,其效果与剂量相关,其机制可能与舒芬太尼可抑制与TNF-α和IL-1β相关的炎性反应有关。

Objective： To investigate the effects of sufentanil on the postoperative cognitive function dysfunction（ POCD） and explore its pathogenesis mechanisms. Methods： 72 cases of elderly patients undergoing articulation coxae surgery with ASA Ⅱ-Ⅲ spinal-epidural combined anesthesia were randomly divided into three groups： low-dose group（ group L,n = 21,sufentanil 0. 05 ug·kg）,high-dose group（ group H,n =22,sufentanil 0. 1 ug·kg） and control group（ group C,n = 29,saline 2 mL）. IL-1β and TNF-α were measured before and after the operation. MMSE was adopted to estimate the cognitive function on the instant,1 d,3 d and 7 d after the surgeon. Results： Compared with those before the surgery,MMSE scores decreased significantly on the instant,1 d,3 d and 7 d after the surgeon（ P ﹤ 0. 05）. The incidence rate of POCD on the instant,1 d,3 d and 7 d after the surgeon in group H was lower than that in group C and group L（ P ﹤ 0. 05）. The levels of IL-1β and TNF-α increased significantly compared with those before the surgery,and the levels of IL-1β and TNF-α in group H were lower than those in group C and L（ P ﹤ 0. 05）. Conclusion： Sufentanil reduces the incidence rate of POCD. The effect is associated with the dose,and its mechanism may be associated with its inhibition effect on the inflammatory reaction related with IL-1β and TNF-α.