全身麻醉复合硬膜外麻醉对老年肝癌切除术患者术后认知功能及血清髓鞘碱性蛋白、Tau蛋白水平的影响

Effects of General Anesthesia Combined with Epidural Anesthesia on Serum Levels of Myelin Basic Protein and Tau in Elderly Liver Cancer Patients Undergoing Surgery

目的探讨全身麻醉复合硬膜外麻醉对老年肝癌切除术患者术后认知功能及血清髓鞘碱性蛋白(MBP)、Tau蛋白水平的影响。方法选取2018年6月至2019年12月于辽阳市中心医院新城医院择期行肝癌切除术的78例老年肝癌患者为研究对象,按照随机数字表法分为观察组与对照组,各39例。观察组采用全身麻醉复合硬膜外麻醉,对照组采用单纯全身麻醉。比较两组患者拔管时间和完全苏醒时间;观察两组患者术前、术后3 d、术后7 d简易精神状况检测量表(MMSE)评分以及术后认知功能障碍(POCD)发生率;检测两组患者术前、术后3 d、术后7 d血清MBP和Tau蛋白水平。结果观察组拔管时间和完全苏醒时间短于对照组(P<0.05);观察组术后3 d、术后7 d MMSE评分高于对照组(P<0.05),POCD发生率[10.25%(4/39)、5.12%(2/39)]低于对照组[30.76%(12/39)、20.51%(8/39)](P<0.05);观察组术后3 d、术后7dMBP和Tau蛋白水平低于对照组(P<0.05)。结论全身麻醉复合硬膜外麻醉用于老年肝癌切除术患者可加快苏醒时间,减少POCD发生,且降低血清MBP和Tau蛋白水平,发挥神经系统的保护作用。

Objective To explore the effect of general anesthesia combined with epidural anesthesia on cognitive function, the serum levels of myelin basic protein(MBP) and Tau in elderly liver cancer patients undergoing surgery. Methods A total of seventy-eight elderly liver cancer patients undergoing surgery were selected and were randomly divided into an observation group(39 cases) and a control group(39 cases). The observation group received epidural anesthesia, and the control group received general anesthesia. The extubation time and recovery time of the two groups of patients were compared. The mini-mental state examination(MMSE) scores and the incidence of postoperative cognitive dysfunction(POCD) were observed before operation, three days after operation, and seven days after operation. The serum levels of MBP and Tau were detected and compared between the two groups of patients before surgery and after surgery for three days and seven days. Results The extubation time and complete recovery time of the observation group were shorter than those of the control group(P<0.05). The MMSE scores of the observation group were higher than those of the control group after surgery for three days and seven days(P<0.05), while the incidence of POCD of the observation group [10.25%( 4/39), 5.12%(2/39)] were lower than t those of the control group [30.76%(12/39)、20.51 %(8/39)](P<0.05). Conclusion The general anesthesia combined with epidural anesthesia for elderly liver cancer patients undergoing surgery can speed up the recovery time, reduce the occurrence of POCD and the levels of MBP and Tau, and play a protective role in the nervous system.