右美托咪定在降低老年食管癌患者七氟烷吸入麻醉后认知功能障碍发生率中的作用

Effects of Dexmedetomidine in Reducing the Incidence of Cognitive Dysfunction after Sevoflurane Inhalation Anesthesia in Elderly Patients with Esophageal Cancer

探讨右美托咪定在降低老年食管癌患者七氟烷吸入麻醉后认知功能障碍发生率中的作用。方法:选择2016年2月~2019年1月在我院行择期胸腔镜下食管癌根治术的103例患者进行回顾性分析。根据患者接受麻醉方式的不同将其分为两组,对照组(n=52)采用七氟烷吸入麻醉,研究组(n=51)采用右美托咪定联合七氟烷吸入麻醉。比较两组患者认知功能障碍发生率、脑氧代谢指标、血清神经功能指标及白介素、基质金属蛋白酶。结果:研究组患者术后1周认知功能障碍发生3例(5.89%),低于对照组的10例(19.23%),两组对比具有统计学差异(P<0.05)。研究组患者颈内静脉球血氧含量(CjvO2)、颈静脉血氧饱和度(SjvO2)和脑氧摄取率(CERO2)水平均高于对照组(P <0. 05)。术前两组患者的血髓鞘碱性蛋白(MBP)、神经元特异性烯醇化酶(NSE)、血清神经胶质细胞原纤维酸性蛋白(GFAP)均无统计学差异(P>0. 05),术后研究组患者MBP、NSE均低于对照组,GFAP高于对照组(P <0.05)。术前两组患者的白介素-1β(IL-1β)、白介素-6(IL-6)、基质金属蛋白酶3(MMP-3)、基质金属蛋白酶9(MMP-9)无统计学差异(P>0. 05),术后研究组患者IL-1β、IL-6、MMP-3、MMP-9水平均低于对照组(P<0.05)。结论:右美托咪定可降低老年食管癌患者七氟烷吸入麻醉后认知功能障碍的发生率,其作用机制可能与改善脑氧代谢、神经功能,缓解炎症反应及降低基质金属蛋白酶水平有关。

Objective:To investigate the effects of dexmedetomidine in reducing the incidence of cognitive impairment in elderly patients with esophageal cancer after sevoflurane inhalation anesthesia.Methods:A retrospective analysis was performed in the 103 patients who underwent thoracoscopic radical esophagectomy in our hospital from February 2016 to January 2019.According to the way of anesthesia,patients were divided into two groups.52 patients in the control group used sevoflurane inhalation anesthesia alone,and 51 patients in the observation group received dexmedetomidine and sevoflurane inhalation anesthesia.The incidence of cognitive dysfunction,cerebral oxygen metabolism index,serum neurological function,interleukin and matrix metalloproteinase were compared between the two groups.Results:In the observation group,3 patients(5.89%)had cognitive dysfunction 1 week after operation,which was significantly lower than that in the control group(19.23%,P<0.05).The levels of jugular oxygen content(CjvO2),jugular venous oxygen saturation(SjvO2)and cerebral extraction ratio for oxygen(CERO2)in the observation group were significantly higher than those in the control group(P<0.05).There were no significant differences in myelin basic protein(MBP),neurone-specific enolase(NSE)and glial fibrillar acidic protein(GFAP)between the two groups before operation(P>0.05).The MBP and NSE in observation group after operation were significantly higher than those of the control group(P<0.05).There was no significant difference in the levels of IL-1β,IL-6,MMP-3 and MMP-9 between the two groups before operation(P>0.05).The levels of IL-1β,IL-6,MMP-3 and MMP-9 in the observation group after operation were significantly lower than those in the control group(P<0.05).Conclusion:Dexmedetomidine can significantly reduce the incidence of cognitive dysfunction after sevoflurane inhalation anesthesia in elderly patients with esophageal cancer.The mechanism may be related to the enhancement of cerebral oxygen metabolism and neurological function,alleviation of inflammation and decreasing matrix metalloproteinase levels.