丙泊酚复合七氟烷不同配伍麻醉对老年患者胃肠道肿瘤手术术后认知功能及血清中枢神经特异性蛋白、神经元特异性烯醇化酶、兴奋性氨基酸水平的影响

Impact of propofol combined with sevoflurane anesthesia on postoperative cognitive function and serum levels of S100β, neuron specific enolase, and excitatory amino acids in elderly patients

目的为老年胃肠道肿瘤手术患者探究最佳的麻醉配伍方法,以降低老年患者术后认知功能障碍的发生率。方法研究选取2022年1月至2023年12月在嘉兴大学附属第二医院进行胃肠道肿瘤手术老年患者124例,采用随机数字表法将患者分为4组(n=31):丙泊酚组(A组)、七氟烷组(B组)和丙泊酚/七氟烷不同配伍组(AB1组和AB2组)。A组靶控输注丙泊酚血浆靶浓度2~4μg/ml;B组吸入七氟烷1.7%~2.2%;AB1组靶控输注丙泊酚血浆靶浓度1.2μg/ml,吸入七氟烷0.7%~1.2%;AB2组靶控输注丙泊酚血浆靶浓度0.6μg/ml,吸入七氟烷1.2%~1.7%。比较患者的一般资料;术前1 d和术后7 d中枢神经特异性蛋白(S100β)、神经元特异性烯醇化酶(NSE)、兴奋性氨基酸(EAA)水平;术前1 d和术后7 d采用简易智力状态量表(MMSE)评分和蒙特利尔量表(MoCA)评估术后认知功能。结果经过纳排标准,最终119例纳入研究,两组患者的基线资料比较,差异无统计学意义;T0时,4组S100β、NSE、EAA比较,差异无统计学意义(P>0.05);与AB1组比较,A、B和AB2组T1时S100β、NSE和EAA较低[(12.3±1.1)μg/ml比(15.7±1.9)、(14.2±1.5)、(13.5±1.2)μg/ml,t=-8.302、-5.727、-4.177,P<0.05;(680.5±58.6)ng/L比(812.5±78.5)、(782.6±70.5)、(738.5±71.5)ng/L,t=-7.300、-6.040、-3.402,P<0.05;(22.5±2.0)μmol/L比(30.5±2.9)、(28.5±2.5)、(25.3±2.2)μmol/L,t=-12.329、-10.366、-5.048,P<0.05],差异有统计学意义;在T0时,4组的MMSE评分和MoCA评分比较,差异无统计学意义(P>0.05);与AB1组比较,A、B和AB2组T1时MMSE评分和MoCA评分较低(27.6±1.4比26.3±1.4、26.6±1.2、26.9±0.8,t=4.150、3.426、3.361,P<0.05;27.6±1.2比25.4±1.2、25.9±1.3、26.4±1.2,t=7.139、5.137、3.688,P<0.05),差异有统计学意义。AB1组POCD发生率低于A、B和AB2组[1例(3.4%)比11例(36.7%)、9例(30.0%)、8例(26.7%),χ2=8.097、5.619、4.252,P<0.05],差异有统计学意义。结论丙泊酚血浆靶浓度1.2μg/ml配伍七氟烷0.7%~1.2%可以显著降低胃肠道肿瘤手术老年患者POCD的发生。

ObjectiveTo explore the best anesthetic compatibility method for elderly patients with gastrointestinal tumor surgery,in order to reduce the incidence of postoperative cognitive dysfunction in elderly patients.MethodsThe study selected 124 elderly patients undergoing gastrointestinal tumor surgery at the Second Affiliated Hospital of Jiaxing University from January 2022 to December 2023.Patients were randomly divided into four groups(n=31)using a random number table method:Propofol group(group A),Sevoflurane group(group B),and two different Propofol/Sevoflurane combination groups(group AB1 and group AB2).Group A received target-controlled infusion of Propofol with a plasma target concentration of 2-4μg/ml.Group B received inhalation of Sevoflurane at 1.7%-2.2%.Group AB1 received target-controlled infusion of Propofol with a plasma target concentration of 1.2μg/ml and inhalation of Sevoflurane at 0.7%-1.2%.Group AB2 received target-controlled infusion of Propofol with a plasma target concentration of 0.6μg/ml and inhalation of Sevoflurane at 1.2%-1.7%.General information of the patients was compared.S100β,neuron specific enolase(NSE),and excitatory amino acids(EAA)levels were measured 1 day before and 7 days after surgery.Cognitive function was assessed using the mini mental state examination(MMSE)and the montreal cognitive assessment(MoCA)1 day before and 7 days after surgery.ResultsAfter applying the inclusion and exclusion criteria,119 patients were included in the study.There was no significant difference in baseline data between the two groups.At T0,there was no significant difference in S100β,NSE,and EAA levels among the four groups(P>0.05).Compared with group AB1,the levels of S100β,NSE,and EAA at T1 were lower in group A,group B,and group AB2[(12.3±1.1)μg/ml vs.(15.7±1.9),(14.2±1.5),(13.5±1.2)μg/ml,t=-8.302,-5.727,-4.177,P<0.05;(680.5±58.6)ng/L vs.(812.5±78.5),(782.6±70.5),(738.5±71.5)ng/L,t=-7.300,-6.040,-3.402,P<0.05;(22.5±2.0)μmol/L vs.(30.5±2.9),(28.5±2.5),(25.3±2.2)μmol/L,t=-12.329,-10.366,-5.048,P<0.05],with statistically significant differences.At T0,there was no significant difference in MMSE and MoCA scores among the four groups(P>0.05).The MMSE and MoCA scores at T1 were lower in group A,group B,and group AB2 than in group AB1(27.6±1.4 vs.26.3±1.4,26.6±1.2,26.9±0.8,t=4.150,3.426,3.361,P<0.05;27.6±1.2 vs.25.4±1.2,25.9±1.3,26.4±1.2,t=7.139,5.137,3.688,P<0.05),with statistically significant differences.The incidence of POCD in group AB1 was lower than that in group A,group B,and group AB2[1 case(3.4%)vs.11 cases(36.7%),9 cases(30.0%),8 cases(26.7%),χ2=8.097,5.619,4.252,P<0.05],with statistically significant differences.ConclusionIn this study,the plasma target concentration of propofol(1.2μg/ml)combined with sevoflurane(0.7%-1.2%)can significantly reduce the incidence of POCD in elderly patients undergoing surgery for gastrointestinal tumors.