控制性降压麻醉对老年肠癌根治术患者应激反应及术后认知功能的影响

The effect of controlled blood pressure anesthesia for elderly bowel cancer radical operation patients on stress response and postoperative cognitive function

目的分析控制性降压麻醉对老年肠癌根治术患者应激反应及术后认知功能的影响。方法选择该院2017年4月至2020年4月收治的120例老年肠癌根治术患者为研究对象,以双盲随机抽样法分为研究组与对照组,每组60例,对照组实施全身麻醉,研究组在对照组基础上实施控制性降压麻醉,比较两组不同时间点平均动脉压(MAP)、心率、简易智力状态检查量表(MMSE)评分、血清神经元特异性烯醇化酶(NSE)及S100β蛋白水平、认知功能障碍(POCD)发生率。结果气管插管1 min后、拔管时研究组MAP、心率均明显低于对照组;术后6、24 h,研究组MMSE评分明显高于对照组,血清NSE、S100β蛋白水平均明显低于对照组;术后4、24、48 h研究组POCD发生率(3.33%、1.67%、0.00%)均明显低于对照组(23.33%、16.67%、11.67%),差异有统计学意义(P<0.05)。结论控制性降压麻醉可有效减轻老年肠癌根治术患者应激反应,改善认知功能,降低POCD发生率,值得借鉴。

Objective To analyze the effect of controlled blood pressure anesthesia on stress response and postoperative cognitive function in elderly patients undergoing radical operation for bowel cancer.Methods A total of 120 elderly patients with bowel cancer undergoing radical operation from April 2017 to April 2020 were selected and divided into study group and control group by double-blind random sampling,60 cases in each group.Patients in control group adopted general anesthesia.Patients in study group underwent controlled blood pressure anesthesia on the basis of those of control group,then compared the mean arterial pressure(MAP),heart rate(HR),and scores of the Simple Intelligence Status Check Scale(MMSE),serum neuron-specific enolase(NSE)level,S100βprotein level,and incidence of cognitive dysfunction(POCD)at different time points between the two groups.Results The MAP and HR of study group were significantly lower than those of control group at 1 minute after endotracheal intubation and the tube drawing,the MMSE score of study group was significantly higher than that of control group after operation 6 hours and 24 hours,the serum NSE and S100βprotein levels of study group were significantly lower than those of control group,the incidences of POCD(3.33%,1.67%,0.00%)in study group were significantly lower than those in control group(23.33%,16.67%,11.67%)after operation 4,24,48 h,all the differences were statistically significant(P<0.05).Conclusion Controlled blood pressure anesthesia could effectively reduce the stress response of elderly patients undergoing radical operation for bowel cancer,improve cognitive function,reduce the incidence of POCD,which is worthy of reference.