七氟烷麻醉应用于脑肿瘤切除术患者围手术期的临床评价

Effect of sevoflurane anesthesia on perioperative indexes in patients undergoing brain tumor resection

目的探讨七氟烷麻醉对脑肿瘤切除术患者围手术期的影响。方法选取2020年5月至2021年5月华北理工大学附属医院收治的50例脑肿瘤切除术患者,使用随机抽签法分为对照组和研究组,各25例。对照组患者予以丙泊酚麻醉,研究组予以七氟烷麻醉。比较两组患者苏醒质量、不同时间点[术前24 h(T_(0))、麻醉诱导后(T_(1))、切开硬膜后(T_(2))、手术结束时(T_(3))、术后24 h(T_(4))]血清神经元特异性烯醇化酶(NSE)、S100钙结合蛋白β(S100β)水平、不同时间点(T_(0)、T_(4))血清因子水平[肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)]及不同时间点(术前24 h、术后6 h、术后24 h、术后72 h)简易智能精神状态检查量表(MMSE)评分,并统计两组不良反应发生率。结果研究组苏醒时间[(25.04±5.94)min,(29.37±7.18)min]与拔管时间[(30.48±8.13)min,(37.26±10.52)min]较对照组短(t=2.323,2.550,均P<0.05)。T_(0)、T_(1)时间点,两组患者血清NSE、S100β水平对比均差异无统计学意义(均P>0.05);T_(2)、T_(3)、T_(4)时间点,两组患者血清NSE、S100β水平较T_(0)时升高,且研究组血清NSE、S100β水平均低于对照组(均P<0.05);T_(0)时间点,两组血清TNF-α、IL-6水平均差异无统计学意义(均P>0.05),T_(4)时间点,两组患者血清TNF-α、IL-6水平较T_(0)升高,且研究组血清TNF-α、IL-6水平均低于对照组(均P<0.05)。术前24 h,研究组与对照组MMSE评分差异无统计学意义(P>0.05),术后6 h、术后24 h,研究组和对照组MMSE评分均较术前24 h下降(均P<0.05);术后6 h、术后24 h,研究组MMSE评分均高于对照组[术后6 h:(20.28±1.39)分,(16.77±1.05)分,t=10.075,P<0.001;术后24 h:(22.63±1.52)分,(19.54±1.33)分,t=7.650,P<0.001];术后72 h,两组MMSE评分与术前24 h对比差异无统计学意义,且术后72 h两组间差异无统计学意义(均P>0.05)。研究组不良反应发生率为12.00%(3/25),对照组为20.00%(5/25),两组对比差异无统计学意义(P>0.05)。结论七氟烷麻醉应用于脑肿瘤切除术中,能缩短患者苏醒与拔管时间,减轻脑损伤,抑制炎症反应,降低对早期认知功能的影响,且安全性高。

Objective To investigate the effect of sevoflurane anesthesia on perioperative indexes in patients undergoing brain tumor resection.Methods Fifty patients admitted to the Affiliated Hospital of North China University of Technology for brain tumor resection from May 2020 to May 2021 were selected as the subjects and divided into two groups using random sampling method,with 25 in each group.The patients in the control group were anesthetized with propofol and those in the study group with sevoflurane.The quality of awakening,serum neuron-specific enolase(NSE),and S100 calcium-binding proteinβ(S100β)levels at different time points(24 h before surgery(T_(0)),after induction of anesthesia(T_(1)),after incision of the dura mater(T_(2)),at the end of surgery(T_(3)),and at 24 h after surgery(T_(4))),serum factor levels(tumor necrosis factor-alpha(TNF-α),and interleukin-6(IL-6))at different time points(T_(0),T_(4)),and the mini-mental state examination(MMSE)score at different time points(24 h before,6 h after,24 h after,and 72 h after)were compared between the two groups,and the rates of adverse reactions were calculated in both groups.Results The recovery time and extubation time in the study group were both shorter than those in the control group((25.04±5.94)min vs(29.37±7.18)min,(30.48±8.13)min vs(37.26±10.52)min)(t=2.323,2.550,both P<0.05).There were no statistically significant differences in serum NSE and S100βlevels between the two groups at T_(0) and T_(1)(both P>0.05).Compared with T_(0) time point,the serum NSE and S100βlevels in the study group and control group at T_(2),T_(3),and T_(4) time points increased respectively,and the serum NSE and S100βlevels in the study group at T_(2),T_(3),and T_(4) time points were all lower than those in the control group(all P<0.05).At T_(0) time point,there were no statistically significant differences in the levels of serum TNF-αand IL-6 between the two groups(P>0.05).At T_(4) time point,the levels of serum TNF-αand IL-6 in both groups were higher than those at T_(0) time point,and the levels of serum TNF-αand IL-6 in the study group were both lower than those in the control group(all P<0.05).There was no statistically significant difference in MMSE scores 24 hours before surgery between the two groups(P>0.05).However,at 6 hours and 24 hours after surgery,the MMSE scores in the two groups decreased respectively compared to those 24 hours before surgery.After 6 hours and 24 hours of surgery,the MMSE scores of the study group were higher than those of the control group(6 h after surgery(20.28±1.39)vs(16.77±1.05),t=10.075,P<0.001;24 h after surgery(22.63±1.52)vs(19.54±1.33),t=7.650,P<0.001).As for the MMSE score,there was no statistically significant difference between the two groups 24 hours before surgery(P>0.05),and there was also no significant difference between 24 hours before surgery and 72 hours after surgery either in the study group or in the control group(P>0.05).Meanwhile,there was no significant difference between the two groups 72 hours after surgery(P>0.05).The calculation showed no statistically significant difference in the incidence of adverse reactions between the study group and the control group(12.00%(3/25)vs 20.00%(5/25),P>0.05).Conclusion The application of sevoflurane anesthesia in brain tumor resection can shorten the time of awakening and extubation,reduce brain injury,inhibit inflammatory response and reduce the impact on early cognitive function.Meanwhile,it is of high safety.