七氟醚吸入麻醉对老年早期食管癌内镜下黏膜切除术后恢复、谵妄的影响

Effect of sevoflurane inhalation anesthesia on postoperative recovery and delirium after endoscopic mucosal resection of elderly patients with early esophageal cancer

目的探讨七氟醚吸入麻醉对老年早期食管癌内镜下黏膜切除术后恢复及炎症反应的影响。方法选取四川省遂宁市第三人民医院收治的94例拟行内镜下黏膜切除术治疗的老年早期食管癌患者,采用随机数字表法分为对照组(持续吸入异氟烷维持麻醉)和观察组(持续吸入七氟醚维持麻醉),每组47例。对比2组麻醉苏醒期恢复情况。对比2组不同时刻[麻醉前(T0)、术后2 h(T1)、术后6 h(T2)、术后12 h(T3)]的炎性因子[白细胞介素1(interleukin-1,IL-1)、肿瘤坏死因子α(tumor necrosis factor,TNF-α)]水平。对比2组术后简易智力状态检查量表(mini-mental state examination,MMSE)和40项恢复质量量表(quality of recovery-40 questionnaire,QoR-40)评分及围手术期感染发生情况。结果观察组呼吸恢复时间[(6.12±1.28)min vs.(11.46±3.75)min]、气管拔管时间[(8.65±2.01)min vs.(17.24±5.68)min]及定向力恢复时间[(11.26±3.84)min vs.(23.75±6.74)min]均短于对照组(t=9.239、9.774、11.038,P均<0.001)。血清IL-1、TNF-α水平组间、时间及交互对比,差异有统计学意义(P<0.05);与T0相比,T1、T2及T3时刻2组患者血清血清IL-1、TNF-α水平均升高(P<0.05),观察组T1、T2及T3时刻血清IL-1[(32.75±7.43)ng/L vs.(36.08±8.27)ng/L、(35.28±5.32)ng/L vs.(40.15±8.46)ng/L、(40.31±6.08)ng/L vs.(45.74±7.53)ng/L]、TNF-α[(34.26±8.84)ng/L vs.(39.86±9.02)ng/L、(33.28±8.69)ng/L vs.(48.42±9.13)ng/L、(43.75±9.46)ng/L vs.(58.15±9.83)ng/L]水平均低于对照组(P<0.05)。术后3 d观察组QoR-40评分[(182.21±9.84)分vs.(175.68±8.43)分]、MMSE评分[(28.84±5.13)分vs.(26.16±5.03)分]高于对照组(t=3.455、2.577,P=0.001、0.012)、谵妄发生率(2.13%)低于对照组(17.02%,P=0.014)。2组感染总发生率(12.77%vs.17.02%)相近(χ^(2)=0.336,P=0.562)。结论老年早期食管癌内镜下黏膜切除术中采用七氟醚吸入麻醉效果较好,可降低谵妄发生率,改善认知功能。

Objective To investigate the effect of sevoflurane inhalation anesthesia on the recovery and inflammatory response after endoscopic mucosal resection for elderly patients with early esophageal cancer.Methods A total of 94 patients with early esophageal cancer who were admitted to the Third People′s Hospital of Suining City for endoscopic mucosal resection were selected and divided into the control group(continuous inhalation of isoflurane to maintain anesthesia,n=47)and the observation group(continuous inhalation of sevoflurane to maintain anesthesia,n=47).The condition during anesthesia recovery was compared between two groups.The levels of inflammatory factors[interleukin-1(IL-1)and tumor necrosis factor-α(TNF-α)]at different time points[before anesthesia(T0),at 2 h after surgery(T1),6 h after surgery(T2),and 12 h after surgery(T3)]were compared between two groups.The mini-mental state examination(MMSE)score,the postoperative 40-item Quality of Recovery Scale(QoR-40),and perioperative infection were compared between two groups.Results Respiratory recovery time[(6.12±1.28)min vs.(11.46±3.75)min],tracheal extubation time[(8.65±2.01)min vs.(17.24±5.68)min]and orientation recovery time[(11.26±3.84)min vs.(23.75±6.74)min]in observation group were shorter than those in the control group(t=9.239,9.774,11.038,all P<0.001).There were significant differences of interactions between groups,time points and timepoints between groups with respect to serum IL-1 and TNF-αlevels(P<0.05).Compared with T0,the serum levels of IL-1 and TNF-αin the two groups were increased at T1,T2 and T3(P<0.05),and the serum IL-1[(32.75±7.43])ng/L vs.(36.08±8.27)ng/L,(35.28±5.32)ng/L vs.(40.15±8.46)ng/L,(40.31±6.08)ng/L vs.(45.74±7.53)ng/L],and TNF-α[(34.26±8.84)ng/L vs.(39.86±9.02)ng/L,(33.28±8.69)ng/L vs.(48.42±9.13)ng/L,(43.75±9.46)ng/L vs.(58.15±9.83)ng/L]at T1,T2 and T3 in the observation group was lower than those in the control group(P<0.05).The QoR-40 score[(182.21±9.84)points vs.(175.68±8.43)points]and MMSE score[(28.84±5.13)points vs.(26.16±5.03)points]in the observation group at 3 d after operation were higher(t=3.455,2.577,P=0.001,0.012),and the incidence of delirium(2.13%)was lower than that of the control group(17.02%,P=0.014).The overall incidence of infection in the two groups(12.77%vs.17.02%)was similar(χ^(2)=0.336,P=0.562).Conclusion Sevoflurane inhalation anesthesia is effective in endoscopic mucosal resection of elderly patients with early esophageal cancer,which can reduce the incidence of delirium and improve cognitive function.