蒙药额尔敦-乌日勒对胸腔镜肺叶切除术老年患者术后认知功能的影响

Effect of Mongolian medicine Eerdun Wurile on postoperative cognitive function in elderly patients undergoing thoracoscopic lobectomy

目的评价蒙药额尔敦-乌日勒对胸腔镜肺叶切除术老年患者术后认知功能的影响。方法拟在全麻下行胸腔镜肺叶切除老年患者60例,年龄≥60岁,性别不限,ASA分级Ⅱ或Ⅲ级,BMI≤28 kg/m^(2),术前简易精神状态检查量表(MMSE)评分≥27分,采用随机数字表法分为2组(n=30):对照组(C组)和额日敦-乌日勒组(E组)。于术前3 d开始,E组口服额日敦-乌日勒15粒/d,C组口服安慰剂,持续7 d。分别于术前3 d服药前(T_(1))、术后24和72 h(T_(2,3))时,抽取外周静脉血标本,采用ELISA法检测血清脑源性神经营养因子(BDNF)、IL-1β、TNF-α和Tau蛋白的浓度。分别于T_(1)和术后5 d(T_(4))时采用MMSE评估患者认知功能,记录认知功能下降(MMSE评分<27分)的发生情况。结果与C组比较,E组T_(2)和T_(3)时血清BDNF浓度升高,IL-1β、TNF-α和Tau蛋白浓度降低,T_(4)时MMSE评分升高,认知功能下降发生率降低(P<0.05)。结论蒙药额尔敦-乌日勒可改善老年胸腔镜手术患者的术后认知功能,其机制可能与减轻全身炎症反应和促进神经细胞修复再生有关。

Objective To evaluate the effect of Mongolian medicine Eerdun Wurile on postoperative cognitive function in elderly patients undergoing thoracoscopic lobectomy.Methods Sixty elderly patients of either gender,aged≥60 yr,of American Society of Anesthesiologists Physical Status classificationⅡorⅢ,with body mass index≤28 kg/m^(2),with preoperative Mini-Mental State Examination(MMSE)score≥27 points,undergoing thoracoscopic lobectomy under general anesthesia,were divided into 2 groups(n=30 each)using the random number table method:control group(group C)and Eerdun Wurile group(group E).Eerdun Wurile 15 capsules per day were taken for 7 consecutive days starting from 3 days before surgery in group E,and placebo was given instead in group C.The peripheral venous blood samples were collected before medication at 3 days before surgery(T_(1))and 24 and 72 h after surgery(T_(2,3))for determination of the concentrations of serum brain-derived neurotrophic factor(BDNF),interleukin-1beta(IL-1β),tumor necrosis factor-alpha(TNF-α)and Tau proteins by enzyme-linked immunosorbent assay.The patients′cognitive function was assessed by MMSE at T_(1) and 5 days after surgery(T_(4)),and the occurrence of cognitive decline(MMSE score<27)was recorded.Results Compared with group C,the serum BDNF concentration was significantly increased at T_(2) and T_(3),and the concentrations of IL-1β,TNF-αand Tau protein were decreased,the MMSE score was increased at T_(4),and the incidence of cognitive decline was decreased in group E(P<0.05).Conclusions Mongolian medicine Eerdun Wurile can improve postoperative cognitive function in elderly patients undergoing thoracoscopic surgery,and the mechanism may be related to reduction of systemic inflammatory responses and promotion of nerve cell repair and regeneration.