地氟烷吸入麻醉对老年肥胖患者术后认知功能障碍的影响

Influence of desflurane for inhalation anesthesia on the postoperative cognitive dysfunction in elder obesity patients

目的探讨地氟烷吸入麻醉对老年肥胖患者术后认知功能障碍的影响。方法采用前瞻性研究方法,选择笔者所在医院2017年1月—2017年6月择期行腔镜下腹部手术的老年肥胖患者60例。将入选的患者随机分为对照组和观察组,每组30例患者。对照组采取丙泊酚联合瑞芬太尼靶控输注麻醉,观察组则采用地氟烷吸入麻醉,记录各组患者的围术期相关情况,术前2~3 d及术后1 d和7 d进行简易精神状态测验评分(MMSE)和蒙特利尔认知评定量表评定功能(Mo CA),并用酶联免疫吸附试验检测术前、术后1 d和3 d血清S100β蛋白及炎症因子IL-1β和IL-6水平,比较各组患者术后认知功能障碍和谵妄的发生率。结果两组患者术后1 d MMSE评分均较术前和术后7 d明显降低,观察组患者术后1 d和术后7 d Mo CA评分较术前明显降低。观察组术后1 d MMSE和Mo CA评分较对照组明显增加。与术前比较,对照组术后1 d和术后3 d S100β蛋白浓度明显增高,同时对照组患者术后1 d S100β蛋白浓度明显较观察组升高。两组患者术后1 d和术后3 d炎症因子IL-1β、IL-6浓度明显较术前增高,且术后1 d的炎症因子浓度高于术后3 d。对照组患者术后1 d和术后3 d炎症因子IL-1β、IL-6浓度均较观察组明显增高。两组患者POCD、恶心呕吐、呛咳、躁动和苏醒延迟发生率无明显差异。结论丙泊酚较地氟烷对老年肥胖患者术后认知功能的影响大,但POCD的发生风险无差异。

Objective To explore the impact of desflurane for inhalation anesthesia on the postoperative cognitive dysfunction(POCD)in elder obesity patients.Methods A total of sixty elder obesity patients who underwent scheduled laparoscopic-abdominal surgery under general anesthesia from January 2017 to June 2017 in author's hospital were enrolled for a prospective study,were randomly divided into control and observation group(n=30,for each).The patients in control group were conducted target controlled infusion anesthesia with propofol and remifentanil while those in observation group received inhalation anesthesia with desflurane.The general introduction during surgery and anesthesia between both groups were recorded and compared.Mini-mental state test(MMSE)and Montreal cognitive rating scale(MoCA)at 2 or 3 days before surgery,1 day and 7 day after surgery between both groups were assessed;the level of S100βprotein,interleukin(IL)-1βand IL-6 in serum at 2 or 3 days before surgery,the 1 day and 3 day after surgery between both groups were assessed by using enzyme linked immunosorbent assay.The incidence of postoperative cognitive dysfunction and delirium between both groups were compared.Results The score of MMSE at 1 day after surgery in the two groups were both decreased in comparison with baseline value and that at 7 days after surgery,and the score of MoCA at 1 and 7 days after surgery were both significantly lower than baseline value.Compared with control group,the score of MMSE and MoCA at 1 day after surgery in observation group were both decreased.Then,the level of S100βprotein at 1 and 3 days after surgery in control group were both higher than baseline value,and the level of S100βprotein at 1 day after surgery in control group were up-regulated compared with observation group.The level of IL-1βand IL-6 at 1 and 3 days after surgery in both groups were all higher than baseline value,and the level of inflammatory factors at 1 day after surgery were higher than that at 3 days after surgery.The level of IL-1βand IL-6 at 1 and 3 days after surgery in observation group were both decreased compared with control group,but the incidence of POCD,cough,agitation,delay of recovery,nausea and vomiting after surgery between the two groups were similar.Conclusion The efficacy of desflurane on postoperative cognitive function in elder obesity patients is superior to anesthesia with propofol combined remifentanil,but the incidence of POCD are similar.