针刺麻醉对老年直肠癌根治术患者术后认知功能和血清S100β、MMP-9、BDNF蛋白水平的影响

Effects of acupuncture anesthesia on postoperative cognitive function and serum levels of S100Β,MMP-9 and BDNF protein in elderly patients undergoing radical resection of rectal cancer

目的观察针刺麻醉对老年直肠癌根治术患者术后认知功能及血清S100β、基质金属蛋白酶-9(MMP-9)、脑源性神经生长因子(BDNF)水平的影响。方法将90例行直肠癌根治术的老年患者随机分为对照组和观察组,每组45例。两组均采取全凭静脉麻醉,观察组于麻醉诱导前30 min开始予以针刺麻醉并持续至术毕。比较两组术中全身麻醉药物用量及术后不同时间点简易精神状态量表(MMSE)评分,统计两组术后7 d认知功能障碍(POCD)发生率,并于手术前后行血清S100β、MMP-9、BDNF检测。结果两组术中维库溴铵、丙泊酚用量比较,差异无统计学意义(P>0.05),而观察组瑞芬太尼用量明显低于对照组(P<0.05)。术后1 d、3 d、7 d,观察组MMSE评分均明显高于对照组(P<0.05)。术后7 d内,观察组患者POCD发生率为11.11%,明显低于对照组的31.11%,差异有统计学意义(P<0.05)。两组术后血清S100β、MMP-9水平相比术前均明显上升(P<0.05),血清BDNF水平相比术前明显降低(P<0.05),但观察组上述指标的变化幅度小于对照组(P<0.05)。结论针刺麻醉能够改善老年直肠癌根治术患者的认知功能,降低POCD发生率,其机制可能与降低血清S100β、MMP-9水平及升高血清BDNF水平有关。

Objective To observe the effects of acupuncture anesthesia on postoperative cognitive function and serum levels of S100β,matrix metalloproteinase-9(MMP-9)and brain-derived neurotrophic factor(BDNF)in elderly patients undergoing radical resection of rectal cancer.Methods A total of 90 elderly patients undergoing radical resection of rectal cancer were randomly divided into control group and observation group,with 45 cases in each group.Both groups were given total intravenous anesthesia,and observation group was given acupuncture anesthesia at 30 min before anesthesia induction until the end of surgery.The intraoperative dosages of general anesthetic drugs and mini-mental state examination(MMSE)scores at different time points after surgery were compared between the two groups.The incidence rate of postoperative cognitive dysfunction(POCD)was counted in the two groups at 7 d after surgery.The levels of serum S100β,MMP-9 and BDNF were detected before and after surgery.Results There were no significant differences in the intraoperative dosages of vecuronium bromide and propofol between the two groups(P>0.05),but the dosage of remifentanil in observation group was significantly lower than in control group(P<0.05).At 1 d,3 d and 7 d after surgery,the MMSE scores in observation group were significantly higher than in control group(P<0.05).Within 7 d after surgery,the incidence rate of POCD in observation group was significantly lower than in control group(11.11%vs.31.11%)(P<0.05).The levels of serum S100βand MMP-9 in the two groups after surgery were significantly higher than those before surgery(P<0.05),and the BDNF level was significantly lower than that before surgery(P<0.05).However,the changes of the above mentioned indexes were less in observation group than in the control group(P<0.05).Conclusion Acupuncture anesthesia can improve the cognitive function and reduce the incidence of POCD in elderly patients undergoing radical resection of rectal cancer.And its mechanism may be related to the decreases of serum S100βand MMP-9 and increase of BDNF.