羟考酮对乳腺癌手术患者麻醉效果及血清S100β、BDNF、Aβ-42/tau水平的影响

Anesthetic effect of oxycodone on breast cancer surgery and its influence on the serum levels of S100β,BDNF and Aβ-42/tau

目的:探讨羟考酮对乳腺癌手术患者麻醉效果及血流动力学与应激指标的影响。方法:将2017年9月至2018年6月中国科学技术大学附属第一医院收治的110例乳腺癌手术患者随机分为对照组和观察组,每组55例。对照组与观察组分别采用舒芬太尼、羟考酮进行全麻。比较两组患者麻醉维持时间、苏醒时间、拔管时间、术中用药及麻醉药用量情况,分析两组患者解除机械通气2 h、4 h、8 h、12 h及24 h的视觉模拟量表(VAS)评分;在麻醉前、术后1 d及术后7 d用简易智能精神状态检查量表(MMSE)对患者的认知功能进行评价;观察两组患者术前、术后1 d血清S100β、脑源性神经营养因子(BDNF)、Aβ-42/tau水平的变化。结果:两组麻醉用时、苏醒用时、拔管用时、术中麻醉用药量及术中用药例数比较无明显差异(P>0.05)。观察组各时刻VAS评分均显著低于对照组,术后1 d和术后7 d的MMSE评分明显高于对照组(P<0.05)。术后1 d,两组血清S100β水平明显升高,而血清BDNF及Aβ-42/tau水平明显下降,且观察组术后1 d的S100β水平显著低于对照组,BDNF、Aβ-42/tau显著高于对照组(P<0.05)。观察组术后认知功能障碍(POCD)发生率(5.45%)显著低于对照组(21.82%)(P<0.05)。结论:对乳腺癌手术患者采用羟考酮进行麻醉,镇痛效果显著,可减轻认知功能障碍,可降低POCD发生率,具有一定的临床应用价值。

Objective:To investigate the effect of oxycodone on anesthesia,hemodynamics and stress index in patients undergoing breast cancer surgery.Methods:A total of 110 patients with breast cancer who underwent operation in our hospital from September 2017 to June 2018 were randomly divided into a control group and an observation group,with 55 cases in each group.The patients in the control group were treated with sufentanil for general anesthesia,and those in the observation group were treated with oxycodone.The duration of anesthesia,recovery time,extubation time,intraoperative drug use and anesthetic dosage were compared between the two groups,and the visual analogue score(VAS score) at 2 h,4 h,8 h,12 h and 24 h after mechanical ventilation was analyzed.The mini-mental state examination(MMSE) score and serum levels of S100β,BDNF and Aβ-42/tau were observed and compared.Results:There was no significant difference in the duration of anesthesia,recovery time,extubation time,intraoperative drug use and anesthetic dosage between the two groups(P>0.05).The VAS score at different time points in the observation group was significantly lower than that in the control group,while the MMSE score was significantly higher at 1 d and 7 d post-operation(P<0.05).The serum S100β level increased while serum BDNF level and Aβ-42/tau ratio decreased at 1 d after operation(P<0.05),and the S100β level in the observation group was significantly lower than that in the control group, while BDNF and Aβ-42/tau were significantly higher on day 1 after operation(P<0.05).The incidence of postoperative cognitive dysfunction(POCD) was significantly lower in the observation group(5.45%) than that in the control group(21.82%)(P<0.05).Conclusion:Oxycodone has significant analgesic effect on breast cancer surgery.It can alleviate cognitive impairment and reduce the incidence of POCD.