七氟烷麻醉对老年肺癌患者术后血清IL-1、ICAM-1表达及肺部并发症的影响

The effects of sevoflurane anesthesia on the expressions of IL-1,ICAM-1 after operation and lung complications in elderly patients with lung cancer

目的探究七氟烷麻醉对老年肺癌患者术后白细胞介素1(interleukin-1,IL-1)、细胞间黏附因子1(intercellular cell adhesion molecule-1,ICAM-1)表达及肺部并发症的影响。方法选取老年肺癌患者128例,按照随机数字表法分为研究组和对照组,每组64例。2组均采用老年肺癌手术,对照组给予丙泊酚全身麻醉,研究组给予七氟烷麻醉。比较2组简易智力状态检查量表(mini mental state examination scale,MMES)评分、术后认知障碍发生情况、血清炎性因子水平[IL-1、ICAM-1、血管内皮生长因子(vascular endothelial growth factor,VEGF)]、疼痛介质[P物质(substance P,SP)、缓激肽(bradykinin,BK)、白细胞介素6(interleukin-6,IL-6)]以及术后并发症发生情况。结果2组MMSE评分均呈先降低后升高趋势,研究组MMSE评分波动幅度小于对照组,组间、时点间、组间·时点间交互作用差异有统计学意义(P<0.05)。研究组术后8 h、24 h、3 d认知障碍发生率均明显低于对照组,差异有统计学意义(P<0.05)。术后,2组IL-1、ICAM-1、VEGF水平明显低于术前,研究组IL-1、ICAM-1、VEGF水平明显低于对照组,差异有统计学意义(P<0.05)。2组SP、BK、IL-6水平明显低于术前,研究组SP、BK、IL-6水平明显低于对照组,差异有统计学意义(P<0.05)。研究组肺炎、脓痰、发热及痰培养阳性等并发症发生率明显低于对照组,差异有统计学意义(P<0.05)。结论老年肺癌患者使用七氟烷麻醉可有效改善术后认知功能,降低认知障碍发生率,降低血清炎性因子水平及疼痛介质水平,减少肺部并发症发生率,安全有效。

Objective To investigate the effects of sevoflurane anesthesia on the expressions of interleukin-1(IL-1),intercellular cell adhesion molecule-1(ICAM-1)after operation and lung complications in elderly patients with lung cancer.Methods A total of 128 elderly patients with lung cancer were selected and divided into research group(n=64)and control group(n=64)according to the random number table method.The elderly lung cancer patients in both groups received surgery.The control group was given propofol general anesthesia before operation,and the research group was given sevoflurane anesthesia.The mini mental state examination scale(MMES)score,the incidence of postoperative cognitive impairment,the levels of serum inflammatory factors[interleukin-1(IL-1),intercellular cell adhesion molecule-1(ICAM-1),vascular endothelial growth factor(VEGF)],pain mediators[substance P(SP),bradykinin(BK),interleukin-6(IL-6)]and postoperative complications were compared between the two groups.Results The MMSE scores of the two groups both decreased initially and then increased;the fluctuation range of the MMSE scores of the research group was smaller than that of the control group,and the differences in the interaction between groups,time points,and time points between groups were statistically significant(P<0.05).The incidence of cognitive impairment in the research group at 8 h,24 h,and 3 d after surgery was significantly lower than that in the control group,and the difference was statistically significant(P<0.05).After operation,the levels of IL-1,ICAM-1,and VEGF in the two groups were significantly lower than those before operation,and the levels of IL-1,ICAM-1,and VEGF in the research group were significantly lower than those of the control group,with significant difference(P<0.05).The levels of SP,BK,and IL-6 in the two groups were significantly lower than those before surgery,and the levels of SP,BK,and IL-6 in the research group were significantly lower than those in the control group,suggesting significant difference(P<0.05).The incidence of complications such as pneumonia,purulent sputum,fever and positive sputum culture in the research group was significantly lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusion Sevoflurane anesthesia can effectively improve the postoperative cognitive function of elderly patients with lung cancer,and reduce the incidence of cognitive impairment,the levels of serum inflammatory factors,pain mediators and the incidence of lung complications,which is safe and effective.