右美托咪定对老年结直肠癌患者术后认知功能及血浆miR-206、BDNF水平的影响

Effects of dexmedetomidine on postoperative cognitive function and plasma miR-206 and BDNF levels in elderly patients with colorectal cancer

目的:探究右美托咪定(DEX)对老年结直肠癌患者术后认知功能及血浆微小RNA-206(miR-206)、脑源性神经生长因子(BDNF)水平的影响。方法:选取2018年1月至2019年12月期间在我院计划行全身麻醉腹腔镜下结直肠癌手术的老年患者160例,按照随机数字表法分为两组各80例。研究组患者麻醉前10 min给予DEX 1 mg·kg^(-1),术中给予DEX 0.3 mg·(kg·h)^(-1)至手术结束前30 min;对照组患者给予等量生理盐水代替DEX。比较两组患者术后3、7 d时术后认知功能障碍(POCD)发生率和术后1、3、7 d时血浆miR-206、BDNF水平以及不良反应发生情况。根据术后7 d时POCD发生情况,将患者分为POCD组和非POCD组,进行两组间血浆miR-206、BDNF水平的比较。结果:研究组患者的POCD发生率低于对照组,且术后1、3、7 d时的血浆BDNF水平高于对照组,而血浆miR-206相对表达量则低于对照组(P<0.05)。另外,POCD组患者术后1、3、7 d时血浆BDNF水平均显著低于非POCD组,血浆miR-206相对表达量高于非POCD组(P<0.05)。术后1 d时血浆miR-206相对表达量预测术后3、7 d发生POCD的曲线下面积分别为0.78(95%CI为0.67~0.84,P<0.001)、0.82(95%CI为0.71~0.89,P<0.001)。且术后1 d时血浆miR-206相对表达量>4.10是老年结直肠癌患者术后7 d时发生POCD的独立危险因素(P<0.05)。结论:DEX可以降低老年患者全麻下结直肠癌手术POCD的发生风险,这可能与其能降低血浆miR-206水平、增加血浆BDNF水平有关。

Objective:To investigate the effects of dexmedetomidine(DEX)on postoperative cognitive function,plasma microRNA-206(miR-206)and brain derived neurotrophic factor(BDNF)levels in elderly patients with colorectal cancer.Methods:One hundred and sixty elderly patients undergoing elective colorectal cancer surgery under general anesthesia in our hospital from January 2018 to December 2019 were selected.The patients were divided into study group and control group according to the random number table method,with 80 patients in each.Patients in the study group were given DEX 1 mg·kg^(-1)10 min before anesthesia,and 0.3 mg·(kg·h)^(-1) intraoperatively until 30 min before the end of surgery.The patients in the control group were given the same amount of normal saline instead of DEX.The incidence of postoperative cognitive dysfunction(POCD)and the plasma miR-206,BDNF levels and adverse reactions at postoperative 1,3 and 7 days were compared between the two groups.According to the occurrence of POCD at postoperative 7 days,patients were divided into POCD group and non-POCD group.Results:The incidence of POCD in the study group was lower than that in the control group,and on postoperative 1,3 and 7 days,the plasma BDNF level in the study group was higher than that in the control group,meanwhile,the relative transcript level of plasma miR-206 in the study group was lower than that in the control group(P<0.05).The plasma BDNF level of POCD patients was significantly higher than that of the non-POCD group at postoperative 1,3 and 7 days(P<0.05),and the relative transcript level of plasma miR-206 was also higher than that of the non-POCD group(P<0.05).The areas under the curve of miR-206 in plasma at postoperative day 1 for predicting the occurrence of POCD at postoperative 3 and 7 days were 0.78(95%CI 0.67-0.84,P<0.001)and 0.82(95%CI 0.71-0.89,P<0.001)respectively.Moreover,miR-206 in plasma at postoperative 1 day>4.10 was an independent risk factor for POCD in elderly colorectal cancer patients at postoperative 7 days(P<0.05).Conclusion:DEX can reduce the risk of POCD in elderly patients under general anesthesia with colorectal cancer surgery,which may be related to the decreased miR-206 expression and increased BDNF level in plasma.