全身麻醉对中青年妇科腹腔镜术后记忆功能的影响

Effects of General Anesthesia on Postoperative Memory Function of Young and Middle-aged Gynecological Patients Undergoing Laparoscopic Surgery.

目的探讨全身麻醉对中青年妇科腹腔镜手术患者术后早期记忆功能及血清白细胞介素-6(interleukin-6,IL-6)、S100β蛋白(S100-β)及脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)水平的影响。方法选择2021年就诊于山西医科大学第二医院,拟在全身麻醉下行腹腔镜子宫肌瘤剔除或卵巢囊肿剥除术的60例患者,采用随机数字表法将其分为全凭静脉麻醉组(A组)和静吸复合麻醉组(B组),每组各30例。术前1天(T_(0))和术后3天(T_(3))采用Rivermead行为记忆测验(第3版)(RBMT-Ⅲ)对患者的记忆功能进行评分,术后1周及1个月进行电话随访。麻醉前(T_(1))、入麻醉后恢复室(postanesthesia care unit,PACU)后30min(T_(2))及术后3天(T_(3))静脉采血,检测血清中IL-6、S100B及BDNF水平。记录生命体征、麻醉时长、气腹时长、苏醒时长及不良反应。结果记忆功能:A、B两组患者的RBMT-Ⅲ评分术后均下降,但组间比较,差异无统计学意义(P>0.05)。血清IL-6、S100B及BDNF水平:A、B两组患者的IL-6、S100B水平在T_(2)、T_(3)较T_(1)显著增高(P<0.05);BDNF水平在3个时间点无明显变化,组间比较差异无统计学意义(P>0.05)。A、B两组患者术后不良反应发生率比较,差异无统计学意义(P>0.05)。按年龄再分组:围绝经期组(45~55岁)术后RBMT-Ⅲ评分明显低于非围绝经期组(20~44岁),差异有统计学意义(P<0.05),而血清IL-6、S100B及BDNF水平比较差异无统计学意义(P>0.05)。结论对于中青年妇科患者,手术麻醉对术后早期记忆功能可能存在一定影响,特别是对围绝经期的患者影响更为显著。

Objective To investigate the effect of general anesthesia on early postoperative memory function and the levels of plasma interleukin-6(IL-6),S100B protein(S100B)and brain-derived neurotrophic factor(BDNF)in young and middle-aged gynecological laparoscopic surgery patients.Methods Sixty patients with laparoscopic myomectomy or ovarian cystectomy under general anesthesia were selected and randomly divided into total intravenous anesthesia group(group A)and intravenous inhalation combined anesthesia group(group B),with 30 cases in each group.The memory function was scored by Rivermead Behavioral Memory Test(Third Edition)(RBMT-Ⅲ)at 1day before surgery(T_(0))and 3days after surgery(T_(3)),The patients were followed up by telephone at 1 week and 1month after surgery.Venous blood was collected before anesthesia(T_(1)),30minutes after entering the postanesthesia care unit(T_(2)),3days after surgery(T_(3))to detect the levels of IL-6,S100B and BDNF in plasma.The patient′s vital signs,duration of anesthesia,duration of pneumoperitoneum,duration of recovery,and perioperative adverse reactions were recorded.Results Memory function:the RBMT-Ⅲscores of patients in both groups decreased after operation compared with those before operation,but there was no statistical significance between the two groups(P>0.05).The levels of IL-6,S100B and BDNF in plasma:the levels of IL-6 and S100B in both groups were higher at T_(2)and T_(3)than at T_(1)(P<0.05),while the levels of BDNF did not change at the three time points,there was no significant difference between groups(P>0.05).There was no significant difference in the incidence of adverse reactions between the groups(P>0.05).Re-grouping by age:the postoperative RBMT-Ⅲscore of the perimenopausal group(45-55 years)was lower than that of the non-perimenopausal group(20-44 years),and the difference was statistically significant(P<0.05);while there was no significant difference in the levels of IL-6,S100B and BDNF in plasma between the groups(P>0.05).Conclusion For young and middle-aged gynecological patients,surgical anesthesia may have a certain impact on early postoperative memory function,especially for perimenopausal patients.