右美托咪定调节PI3K/AKT信号通路对老年全身麻醉患者术后认知功能的影响

Effect of dexmedetomidine regulating PI3K/AKT signal pathway on postoperative cognitive function of elderly patients under general anesthesia

目的探讨右美托咪定调节血清磷脂酰肌醇-3-羟基酶(PI3K)/丝氨酸-苏氨酸蛋白激酶(AKT)信号通路对老年全身麻醉患者术后认知功能的影响。方法选取2021年2月至2022年2月在荆门市第二人民医院行全麻手术的老年患者82例进行前瞻性研究,采用抽签法将所有患者分为观察组和对照组,各41例。观察组在全身麻醉诱导开始10 min内静脉泵入右美托咪定,0.8μg/kg,随后以0.2~0.5μg·kg^(-1)·h^(-1)维持泵注;对照组静脉泵等量0.9%氯化钠溶液。观察并记录两组患者术前10 min、拔管前10 min、拔管后30 min的血流动力学指标;记录两组患者术中麻醉药用量及复苏情况。应用精神状态检查表(MMSE)记录患者术前、术后6 h、术后1 d、术后3 d MMSE评分,比较两组患者术前及术后即刻、术后1 d、术后3 d血清PI3K及AKT蛋白表达水平;通过Spearman秩相关分析检验PI3K、AKT与全身麻醉患者术后认知功能的相关性。结果与对照组比较,观察组拔管前10 min、拔管后30 min平均动脉压明显降低、心率明显减缓,差异均有统计学意义(P<0.05)。观察组术中使用丙泊酚及瑞芬太尼用量明显少于对照组,术后复苏各指标时间短于对照组,差异均有统计学意义(P<0.05)。观察组术后6 h MMSE评分低于术前,对照组术后6 h、术后1 d MMSE评分均低于术前,差异均有统计学意义(P<0.05);观察组术后6 h MMSE评分为(25.15±5.22)分,明显高于对照组[(21.57±3.58)分],差异有统计学意义(P<0.05)。术后即刻、术后1 d、术后3 d,两组PI3K、AKT水平均显著高于术前,观察组术后即刻、术后1 d、术后3 d PI3K、AKT水平均显著低于对照组,差异均有统计学意义(P<0.05)。经单因素相关分析,患者MMSE评分与血清PI3K、AKT水平呈负相关。结论右美托咪定可有效保护老年全身麻醉患者术后认知功能,其作用机制可能与PI3K/AKT信号通路有关。

Objective To investigate the effect of dexmedetomidine on the cognitive function of elderly patients after general anesthesia by regulating the signal pathway of serum phosphatidylinositol-3-hydroxylase(PI3K)/serine-threonine protein kinase(AKT).Methods A total of 82 elderly patients who underwent general anesthesia in Jingmen Second People's Hospital from February 2021 to February 2022 were selected for prospective study.All patients were divided into observation group and control group by lottery,with 41 cases in each group.In the observation group,dexmedetomidine(0.8μg/kg)was injected intravenously within 10 minutes after the induction of general anesthesia,and then the injection was maintained at 0.2-0.5μg·kg^(-1)·h^(-1).In the control group,the same amount of normal saline was pumped intravenously.The hemodynamic indexes of the two groups were observed and recorded 10 min before operation,10 min before extubation and 30 min after extubation.The anesthetic dosage and resuscitation of the two groups were recorded.The MMSE scores of patients before operation,6 hours after operation,1 day after operation and 3 days after operation were recorded by MMSE,and the expression levels of PI3K and AKT protein in serum before and immediately after operation,1 day after operation and 3 days after operation were compared between the two groups.Spearman rank correlation analysis was used to test the correlation between PI3K,AKT and postoperative cognitive function of general anesthesia patients.Results Compared with the control group,the average arterial pressure and heart rate in the observation group decreased significantly 10 min before and 30 min after extubation,the differences were statistically significant(P<0.05).The MMSE scores of observation group at 6 h after operation were lower than those before operation,and those of control group at 6 h and 1 d after operation were lower than those before operation,the differences were statistically significant(P<0.05).The MMSE score of the observation group at 6 h after operation was(25.15±5.22)points,which was significantly higher than that of the control group(21.57±3.58)points,the differences were statistically significant(P<0.05).The dosage of propofol and remifentanil used in the observation group was significantly less than that in the control group,and the time of postoperative resuscitation was shorter than that in the control group,the differences were statistically significant(P<0.05).The levels of PI3K and AKT in observation group and control group were significantly higher than those before operation immediately,on the 1st day and on the 3rd day after operation,the levels of PI3K and AKT in the observation group were significantly lower than those in the control group,the differences were statistically significant(P<0.05).Univariate correlation analysis showed that MMSE score was negatively correlated with PI3K and AKT levels in serum.Conclusion Dexmedetomidine can effectively protect the cognitive function of elderly patients after general anesthesia,and its mechanism may be related to PI3K/AKT signaling pathway.