全身麻醉下老年腹腔镜直肠癌根治术患者缺氧诱导因子-1α及脑源性神经营养因子的血清水平与术后认知功能障碍之间的关系

Relationship between Serum Levels of Hypoxia-Inducible Factor-1Α (HIF-1Α) and Brain-Derived Neurotrophic Factor (BDNF) and Postoperative Cognitive Dysfunction (POCD) in Elderly Patients Undergoing Laparoscopic Radical Rectal Cancer Surgery under General

目的 探究全身麻醉下老年腹腔镜直肠癌根治术患者缺氧诱导因子-1α(HIF-1α)及脑源性神经营养因子(BDNF)的血清水平与术后认知功能障碍(postoperative cognitive dysfunction,POCD)之间的关系。方法 回顾性分析2020年5月—2021年8月期间绵阳市中心医院收治的66例开展全身麻醉下老年腹腔镜直肠癌根治术患者的临床资料,采用简易智力状态检查量表(mini-mentalstateexamination,MMSE),在患者在手术前3 d、手术后第1、3、7天评价认知功能,以评价结果为依据,将66例患者分为非POCD(对照组,53例)、POCD者(观察组,13例),采用ELISA法,对两组患者的HIF-1α、BDNF水平进行检测,对比两组HIF-1α、BDNF水平,评价HIF-1α、BDNF水平与POCD之间的关系。结果 与手术前3 d(70.24±2.15)pg/mL相比,观察组患者HIF-1α水平在手术后第3天(143.21±3.67)pg/mL、第7天(130.45±5.61)pg/mL明显上升,差异有统计学意义(P<0.05);观察组在手术后第3天、第7天时BDNF水平明显下降,差异有统计学意义(P<0.05)。对照组患者手术前3 d与手术后第1天相比,BDNF水平明显下降,差异有统计学意义(P<0.05)。手术后第3天时,观察组患者HIF-1α水平明显高于对照组,差异有统计学意义(P<0.05)。在手术第3天、第7天时,观察组患者BDNF水平低于对照组,差异有统计学意义(P<0.05)。对观察组患者进行分析发现HIF-1α水平与MMSE评分呈负相关(r=-0.515),而BDNF水平与MMSE评分呈正相关(r=0.531)。结论 在老年腹腔镜直肠癌根治术患者开展全身麻醉后,检测血清HIF-1α、BDNF水平,可为早期预防POCD的出现提供有效依据。

Objective To explore the relationship between serum levels of hypoxia-inducible factor-1α(HIF-1α) and brain-derived neurotrophic factor(BDNF) and postoperative cognitive dysfunction(POCD) in elderly patients undergoing laparoscopic radical rectal cancer surgery under general anesthesia. Methods The clinical data of 66 elderly patients undergoing laparoscopic radical resection of rectal cancer under general anesthesia in Mianyang Central Hospital from May 2020 to August 2021 were reviewed. Using the Mini-Mental State Examination(MMSE), patients were evaluated for cognitive function 3 d before surgery, 1 d, 3 d, and 7 d after surgery. Based on the evaluation results, 66patients were divided into non-POCD(control group, 53 cases) and POCD patients(observation group, 13 cases). The levels of HIF-1α and BDNF in the two groups were detected by ELISA. The levels of HIF-1α and BDNF in the two groups were compared, and the relationship between the levels of HIF-1α and BDNF and POCD was evaluated. Results Compared with 3 days before surgery(70.24±2.15) pg/mL, the HIF-1αlevel of observation group patients on the 3rd day(143.21±3.67) pg/mL and the 7th day(130.45±5.61) pg/mL increased significantly. The difference was statistically significant(P<0.05). The level of BDNF in the observation group decreased significantly on the 3rd and 7th days after surgery, and the difference was statistically significant(P<0.05). Compared with the first day after surgery, the level of BDNF in the control group was significantly decreased 3 d before surgery, and the difference was statistically significant(P<0.05). On the third day after surgery, the level of HIF-1α in the observation group was significantly higher than that in the control group, and the difference was statistically significant(P<0.05). On the 3rd and 7th day of operation, the BDNF level of the observation group was lower than that of the control group,and the difference was statistically significant(P<0.05). By comparison, it was found that the level of HIF-1α was negatively correlated with the MMSE score(r=-0.515), while the level of BDNF was positively correlated with the MMSE score(r=0.531). Conclusion The detection of serum HIF-1α and BDNF levels after general anesthesia in elderly patients with laparoscopic radical resection of rectal cancer can provide an effective basis for early prevention of POCD.