硬膜外阻滞麻醉术对结肠癌根治术患者认知功能及炎性蛋白表达的影响研究

Effect of Epidural Anesthesia on Cognitive Function and Inflammatory Protein Expression in Patients with Radical Resection of Colon Cancer

目的探究硬膜外阻滞对结肠癌根治术患者认知功能及炎性蛋白表达的影响,为优化结肠癌根治术麻醉方案提供理论依据。方法本次探究对象为2015年2月至2017年2月于我院行结肠癌根治术的92例结肠癌患者,根据麻醉方案的不同进行分组,将采用单纯全身麻醉的45例患者设为对照组,采用硬膜外阻滞复合全身麻醉的47例患者设为观察组。记录2组患者出血量、苏醒时间等手术情况;术前、术后1 d、3 d采用简易精神状态量表(MMSE)评价2组患者认知功能;采用酶联免疫吸附试验(ELISA)检测2组患者术前、术后1 d、3 d血清S-100β蛋白、肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)水平、白细胞介素(IL-1α)、高敏C反应蛋白(hs-CRP);比较2组患者术后1 d Steward苏醒评分以及疼痛(VAS)评分;记录术后恶心呕吐发生情况。结果观察组与对照组术中出血量、丙泊酚用量、瑞芬太尼用量差异无统计学意义(P>0.05),观察组苏醒时间、拔管时间显著低于对照组,差异具有统计学意义(P<0.05);观察组与对照组术后MMSE评分、血清S-100β蛋白、TNF-α、IL-6、IL-1α、hs-CRP水平均显著高于术前,差异具有统计学意义(P<0.05),术后1 d、3 d观察组MMSE评分显著高于对照组,血清S-100β蛋白、TNF-α、IL-6水平显著低于对照组,差异具有统计学意义(P<0.05);观察组术后Steward苏醒评分显著高于对照组,VAS评分显著低于对照组,差异具有统计学意义(P<0.05);观察组恶心呕吐发生率为12.77%,显著低于对照组(31.11%),差异具有统计学意义(P<0.05)。结论相较于单纯全身麻醉,硬膜外阻滞麻醉能显著提升术后认知功能,改善术后S-100β蛋白、TNF-α等炎性因子水平,不良反应发生率更低。

Objective To investigate the effect of epidural anesthesia on the cognitive function and the expression of inflammatory protein in patients with radical resection of colon cancer,and to provide the theoretical basis for the optimization of radical anastomosis of colon cancer. Methods 92 patients with radical resection of colon cancer in our hospital from February 2015 to February 2017 were selected and divided into groups according to the different anesthesia program,45 patients with simple general anesthesia were included into the control group;and 47 patients with epidural anesthesia combined with general anesthesia were included into observation group. The bleeding,wake time and other surgical conditions of patients in two groups were recorded. The mini mental state examination(MMSE)were used to evaluate the cognitive function of the two groups preoperative and postoperative 1 d and 3 d. The levels of serum S-100βprotein,tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),interleukin-1α(IL-1α),and high-sensitivity C-reactive protein(hs-CRP)were measured by enzyme-linked immunosorbent assay(ELISA)in the two groups preoperative and postoperative 1 d and 3 d;The postoperative 1 d Steward recovery scores and visual analogue scale(VAS)scores were compared between the two groups;The incidence of postoperative nausea and vomiting were recorded. Results There was no significant difference between the two groups in the amount of intraoperative bleeding,the usage of propofol and remifentanil(P>0.05). The recovery time and extubation time of the observation group were significantly lower than those of the control group,the difference was statistically significant(P<0.05). The MMSE score,serum S-100β,levels of TNF-α,IL-6,IL-1α and hs-CRP in the two groups were statistically significant before and after surgery(P<0.05). The MMSE score of the observation group was significantly higher than that of the control group at 1 day and 3 d after operation. The levels of serum S-100β protein,TNF-α and IL-6 of the observation group were significantly lower than those of the control group(P<0.05). The score of Steward in the observation group was significantly higher than that in the control group,and the VAS score in the observation group was significantly lower than that of the control group(P<0.05). The incidence of nausea and vomiting in the observation group was 12.77%,which was significantly lower than that in the control group(31.11%),the difference was statistically significant(P<0.05). Conclusion Compared with general anesthesia,epidural anesthesia can significantly improve postoperative cognitive function,postoperative S-100β protein and other inflammatory factors,and have a lower incidence of adverse reactions.