甲氧明不同速率泵注对老年患者腹腔镜胃癌术后早期认知功能及血清炎性因子的影响

The effects of pumping methoxamine at different rates on early cognitive function and serum inflammatory factors in elderly patients after laparoscopic gastric cancer

目的 观察不同速率泵注甲氧明对老年腹腔镜胃癌术后患者早期认知功能及血清炎性因子的影响。方法 选择我院择期行腹腔镜胃癌根治术患者90例,按随机数字表法分为A组、B1组及B2组各30例,分别采用甲氧明单次给药、甲氧明2μg/(kg·min)泵注、甲氧明4μg/(kg·min)泵注。于术前1 d、术后1、3、7 d应用简易智能精神状态量表(MMSE)进行术后认知功能评分,比较术前1 d及术后12 h白细胞介素(IL)-6、IL-10及肿瘤坏死因子(TNF-α)水平,并记录各组术中发生低血压、心动过缓次数及甲氧明补救次数。结果 三组患者术后1、3 d MMSE评分均较术前不同程度下降(P<0.05)。与A组比较,B1、B2组MMSE评分较高,术后12 h IL-6、IL-10、TNF-α水平较低(P<0.05);低血压发生率较低(P<0.05),且B2组低血压发生率及甲氧明补救次数少于B1组(P<0.05)。结论 持续泵注甲氧明可明显降低老年患者腹腔镜胃癌术后认知功能障碍发生率,并能减少炎症介质的释放;甲氧明泵注速度为4μg/(kg·min)时,患者血流动力学更为稳定。

Objective To observe the effects of pumping methoxamine at different rates on early cognitive function and serum inflammatory factors in elderly patients after laparoscopic gastric cancer.Methods Ninety patients who would undergo elective laparoscopic radical gastrectomy in our hospital were selected. The patients were randomly divided into a group A(single methoxamine administration group), a group B1(methoxamine 2 μg/(kg·min) pumping group), and a group B2(methoxamine 4 μg/(kg·min)pumping group), 30 in each group. Postoperative cognitive function of patients before 1 day of operation, after 1 day, 3 and 7 days of operation was scored by Mini-Mental State Examination(MMSE). The levels of interleukin 6(IL-6), IL-10 and tumour necrosis factor-α(TNF-α) between 1 day before operation and 12 hours after operation were compared. The incidence of intraoperative hypotension and bradycardiaas well as methoxamine remedial times were recorded.Results In the three groups, the MMSE scores after 1 day and 3 days of operation were decreased when compared with before surgery(P<0.05). Compared with the group A,the MMSE scores in the groups B1 and B2 were increased(P<0.05). The levels of IL-6, IL-10 and TNF-α after 12hours of operation in the groups B1 and B2 were lower than those in the group A(P<0.05). The incidence of hypotension in the groups B1 and B2 was also lower than that of the group A(P<0.05). Compared with the group B1, the incidence of hypotension and methoxamine remedial timesin the group B2 were lower(P <0.05).Conclusions Continuous pumping of methoxamine can significantly reduce the incidence of cognitive dysfunction in elderly patients after laparoscopic gastric cancerandreduce the release of inflammatory mediators. When the continuous pumping rate of methoxamine is 4 μg/(kg·min), hemodynamics of patients becomes more stable.