右美托咪定调节JAK2/STAT3信号通路对老年胸腔镜患者术后认知功能的影响

Effect of dexmedetomidine regulating the JAK2/STAT3 signaling pathway on postoperative cognitive function in elderly patients undergoing thoracoscopy

目的探讨右美托咪定调节蛋白络氨酸激酶2(JAK2)/信号转导子与激活子3(STAT3)信号通路对老年胸腔镜患者术后认知功能的影响。方法前瞻性选取2020年8月至2023年6月于邯郸市第一医院行胸腔镜手术的老年患者96例,按随机数字表法分为观察组和对照组,每组各48例。观察组患者在全身麻醉插管后持续泵注右美托咪定,对照组给予等量0.9%氯化钠溶液泵注,术毕前30 min停止泵注。比较两组患者术前及术后1、3、5 d时认知功能[简易精神状态检查量表(MMSE)],术前及术后1 d时JAK2/STAT3信号通路相关蛋白(JAK2、P-JAK2和P-STAT3)水平,麻醉诱导前(T 0)、诱导5 min时(T 1)、术毕(T 2)及拔管时(T 3)血流动力学[平均动脉压(MAP)、心率]变化和不良反应发生率。结果观察组术后1、3 d的MMSE评分分别为(26.70±1.24)、(27.24±1.53)分,均显著高于对照组[(25.15±1.16)、(26.71±1.46)分],差异均有统计学意义(P<0.05)。观察组术后1 d的JAK2、P-JAK2、P-STAT3水平分别为0.31±0.07、0.43±0.08、0.37±0.07,均显著低于对照组(0.42±0.09、0.48±0.12、0.44±0.09),差异均有统计学意义(P<0.05)。观察组T 3时心率、MAP水平分别为(82.31±8.43)次/min、(87.43±9.01)mmHg,均显著低于对照组[(86.03±8.74)次/min、(92.41±9.64)mmHg],差异均有统计学意义(P<0.05)。两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论右美托咪定可减少老年胸腔镜患者术后认知功能障碍的发生,这可能与JAK2/STAT3信号通路是氧化应激信号通路之一有关。

Objective To explore the effect of dexmedetomidine regulating the Janus Kinase 2(JAK2)/signal transducer and activator 3(STAT3)signaling pathway on postoperative cognitive function in elderly patients undergoing thoracoscopy.Methods A total of 96 elderly patients who underwent thoracoscopic surgery at Handan First Hospital from August 2020 to June 2023 were prospectively selected and divided into the observation group and the control group according to the random number table method,with 48 cases in each group.The observation group patients continued to pump dexmedetomidine after general anesthesia intubation,while the control group received an equal amount of 0.9%sodium chloride solution saline pump injection.Pump injection was stopped 30 minutes before surgery.The cognitive function[mini mental status examination(MMSE)]of two groups of patients before and 1,3,and 5 days after surgery,the levels of JAK2/STAT3 signaling pathway related proteins(JAK2,P-JAK2,and P-STAT3)before and 1 day after surgery,changes in hemodynamics[mean arterial pressure(MAP),heart rate]before anesthesia induction(T 0),5 minutes after induction(T 1),postoperative(T 2),and extubation(T 3),and the incidence of adverse reactions were compared.Results The MMSE scores of the observation group at 1 and 3 days after surgery were(26.70±1.24),(27.24±1.53)points,respectively,which were significantly higher than those of the control group[(25.15±1.16),(26.71±1.46)points],the differences were statistically significant(P<0.05).The levels of JAK2,P-JAK2,and P-STAT3 in the observation group were 0.31±0.07,0.43±0.08,0.37±0.07,respectively,which were significantly lower than those in the control group at 1 day after surgery(0.42±0.09,0.48±0.122,0.44±0.09),the differences were statistically significant(P<0.05).At T 3,the levels of heart rate and MAP in the observation group were(82.3±18.43)times/min and(87.43±9.01)mmHg,respectively,which were significantly lower than those in the control group[(86.03±8.74)times/min and(92.41±9.64)mmHg],the differences were statistically significant(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Dexmedetomidine can reduce the occurrence of cognitive dysfunction in elderly patients undergoing thoracoscopic surgery,which may be related to the JAK2/STAT3 signaling pathway being one of the oxidative stress signaling pathways.