糖尿病因素对腹腔镜宫颈癌根治术患者术后谵妄的影响

Effect of diabetes on postoperative delirium in patients undergoing laparoscopic radical resection of cervical cancer

目的:探讨糖尿病因素对腹腔镜宫颈癌根治术患者术后谵妄的影响。方法:选择择期行腹腔镜宫颈癌根治术患者60例,拟于全身麻醉下完成,年龄18~64岁,BMI 18.5~24.0 kg/m2,美国麻醉医师协会(ASA)分级Ⅱ级或Ⅲ级。根据患者是否合并2型糖尿病,将其分为2组,非糖尿病组(ND组)和糖尿病组(D组),每组30例。于术后3 d,采用意识模糊评估(CAM)量表评估患者术后谵妄(POD)的发生,每日评估2次,时间间隔超过6 h,记录2组患者POD的发生情况。分别于麻醉诱导前即刻(T0)、术毕(T1)和术后24 h(T2)时采集外周静脉血4 mL,采用ELISA法测定血浆IL-6、S100β蛋白和神经元特异性烯醇化酶(NSE)浓度。记录2组患者麻醉药用量、麻醉恢复室(PACU)停留时间和住院时间。结果:与T0时比较,2组患者T1-2时血浆IL-6、S100β蛋白和NSE浓度升高(P<0.01);与ND组比较,D组T1-2时血浆IL-6、S100β蛋白和NSE浓度升高,POD发生率升高,PACU停留时间延长(P<0.05)。结论:糖尿病因素可增加腹腔镜宫颈癌根治术患者POD的发生几率。

Objective:To clarify the effect of diabetes on postoperative delirium(POD)in patients undergoing laparoscopic radical resection of cervical cancer.Methods:60 patients(American Society of Anesthesiologists physical status II or III),aged 18~64,BMI 18.5~24.0 kg/m2,scheduled for laparoscopic radical resection of cervical cancer under general anesthesia,were divided into 2 groups based on whether they had a history of type 2 diabetes:non-diabetes group(ND group,n=30)and diabetes group(D group,n=30).CAM was used to evaluate the occurrence of POD.Patients were assessed for delirium twice per day from the first to the third postoperative day,with at least 6 hours elapsing between the assessments.The occurrence of POD was recorded in both groups.Peripheral venous blood 4 ml was collected immediately before anesthesia induction(T0),at the end of surgery(T1)and 24h after surgery(T2).The plasma levels of IL-6,S100βand neuron specific enolase(NSE)were determined by ELISA.The anesthetics dosage,time of PACU stay and hospital stay were recorded.Results:Compared with T0,the plasma concentrations of IL-6,S100βand NSE increased at T1-2 in both groups(P<0.01);compared with the ND group,the plasma concentrations of IL-6,S100βand NSE increased at T1-2,the incidence of POD increased,and the PACU stay time prolonged in D group(P<0.05).Conclusion:Diabetes can increase the incidence of POD in patients undergoing laparoscopic radical resection of cervical cancer.