右美托咪啶对腹腔镜肝癌射频消融术老年患者炎症反应及围术期神经认知紊乱的影响

Effect of dexmedetomidine on inflammatory response and perioperative neurocognitive disorder in elderly patients undergoing laparoscopic radiofrequency ablation for liver cancer

目的观察右美托咪啶对腹腔镜下肝癌射频消融术老年患者血清炎症反应及围术期神经认知紊乱的影响。方法择期行电子腹腔镜下肝癌射频消融术老年患者80例,采用随机数字表法随机分为右美托咪啶组(D组)和对照组(C组)。采集患者静脉血检测血清中TNF-α、IL-6、IL-10、CRP和CD11b浓度。并采用简易智能精神状态检查量表(MMSE)和蒙特利尔认知评估量表(Mo CA)对两组患者进行认知功能评定。结果两组患者血清TNF-α、IL-6、CRP和CD11b水平手术开始后各时点均高于术前(P<0.05),且D组低于C组(P<0.01);而两组患者血清IL-10水平于射频消融开始60 min后逐渐升高,且D组高于C组(P<0.01);D组围术期神经认知紊乱发生率低于C组(P<0.05)。结论右美托咪啶可减轻腹腔镜肝癌射频消融术老年患者血清TNF-α、IL-6、CRP和CD11b等促炎因子水平,减轻炎症反应,降低其围术期神经认知紊乱的发生率。

Objective To investigate the effect of dexmedetomidine on serum inflammatory reaction and perioperative neurocognitive disorder in elderly patients undergoing laparoscopic radiofrequency ablation of liver cancer.Methods Eighty elderly patients undergoing elective laparoscopic radiofrequency ablation for liver cancer were randomly divided into two groups:dexmedetomidine group(group D)and control group(group C).Venous blood samples were collected to detect the concentrations of TNF-α,IL-6,IL-10,CRP and CD11b in serum.The cognitive function of the patients in the two groups was evaluated with Mini-Mental State Examination(MMSE)and Montreal Cognitive Assessment(MoC.A).Results The levels of serum TNF-α,IL-6,CRP and CD11b in both groups were higher than those before operation,and the level of serum IL-10 in group D was lower than that in group C after radiofrequency ablation(60 min),and the level of serum IL-10 in group D was higher than that in group C(P<0.05).The incidence of perioperative neurocognitive disorder in group D was lower than that in group C(P<0.05).Conclusion Dexmedetomidine could reduce the serum levels of pro-inflammatory factors such as TNF-α,IL-6,CRP and CD11b in elderly patients undergoing laparoscopic radiofrequency ablation for liver cancer,reduce the inflammatory reaction and reduce the incidence of perioperative neurocognitive disorder.