七氟烷联合瑞芬太尼对老年患者微创手术后认知功能的影响

Effects of sevoflurane combined with remifentanil on cognitive function in elderly patients after laparoscopic surgery

目的观察吸入不同浓度和不同时间的七氟烷联合瑞芬太尼对老年患者微创手术后认知功能的影响。方法选择2015~2018年广东省清远市人民医院胃肠外科接受腹腔镜下完全腹膜外腹股沟斜疝修补术(手术时间满足≤1.5 h或≥3 h)的老年患者128例,年龄65~75岁,受教育程度≥6年,体重指数(BMI)19~24,ASAⅡ~Ⅲ,术前1天MMSE评分≥27分。入选研究对象术中吸入不同浓度的七氟烷,术后再根据吸入时间将研究对象分为4组:1.5%七氟烷≤1.5 h组(LS组,n=33)、1.5%七氟烷≥3 h组(LL组,n=30)、3%七氟烷≤1.5 h组(HS组,n=34)、3%七氟烷≥3 h组(HL组,n=31)。术前1 d、术后7 d和术后14 d应用MMSE评分表评估患者的认知功能;分别于麻醉诱导前(T_0)、术后1 h(T_1)、术后6 h(T_2)、术后1 d(T_3)抽取外周静脉血,用ELISA法检测S100β蛋白和IL-6的浓度。结果 4组间术前1 d、术后7 d和术后14 d的MMSE评分均无明显差异(P>0.05),HL组术后7 d的认知功能减退发生率明显高于其它3组(P<0.05)。LL组T_1、T_2的IL-6和S100β蛋白表达水平明显高于LS组(P<0.05),HL组T_1、T_2的IL-6和S100β蛋白表达水平明显高于HS组和LL组(P<0.05)。结论吸入1.5%七氟烷联合瑞芬太尼的麻醉方式对老年患者微创手术后认知功能的影响较小,安全性较高。

Objective To investigate the influence of different concentration and duration of sevoflurane inhalation anesthesia on postoperative cognitive function in elderly patients undergoing minimally invasive surgery.Methods 128 patients who were scheduled for totally extraperitoneal herniorrhaphy surgery,age 65 to 75 years old,ASAⅡ~Ⅲ,were divided into 4 groups according to the duration and concentration of sevoflurane inhalation:1.5%and≤1.5 h group(LS group,n=33),1.5%and≥3 h group(LL group,n=30),3%and≤1.5 h group(HS group,n=34),3%and≥3 h group(HL group,n=31).The mini-mental state examination(MMSE)was utilized to assess the cognitive function the day before the surgery and 1 d,7 d,14 d after the surgery.Patients--peripheral venous blood samples were collected immediately before the introduction(T0),1 h(T1),6 h(T2)and 24 h(T3)after the operation.The plasma levels of IL-6 and S100-βprotein were measured by enzyme-linked immunosorbent assay(ELISA).Results The difference of MMSE scores in four groups at 1 d,7 d,14 d after the surgery have no significance(P<0.05).The incidence rate of cognitive decline in HL group at 7 d after surgery was higher than the other three groups(P<0.05).Compared with LS group,the concentrations of IL-6 and S100-βprotein in LL group at T1 and T2 were significantly higher(P<0.05).Compared with LL group,the levels of IL-6 and S100-βprotein in HL group at T1 and T2 were significantly higher(P<0.05).Compared with HS group,the concentrations of IL-6 and S100-βprotein in HL group at T1 and T2 were significantly higher(P<0.05).Conclusion Inhalation of 1.5%sevoflurane combined with remifentanil has little effect on cognitive function in elderly patients after minimally invasive surgery,and has high safety.