摘要
目的分析腰硬联合麻醉在老年骨折患者中的应用效果及对Kelch样环氧氯丙烷相关蛋白-1(Keap1)-核因子E2相关因子2(nuclear factor erythroid 2-related factor 2,Nrf2)信号通路活性的影响。方法纳入2022年6月—2023年6月郑州大学附属郑州中心医院收治的100例具备手术指征的老年骨折患者为本次研究对象,采用随机数字表法将100例患者均分为对照着以及观察组,每组各有50例。对照组患者采用全身麻醉,观察组患者采用腰硬联合麻醉,比较两组患者术后转归及Keap1-Nrf2通路活性。结果麻醉后5 min(T1)及麻醉后15 min(T2)时观察组患者心率(heart rate,HR)均显著低于对照组患者(P<0.05);T1及T2时观察组患者平均动脉压(mean arterial pressure,MAP)均显著高于对照组患者(P<0.05)。术后24 h观察组患者简易智力状态检查表(MMSE)评分(25.31±1.32)显著高于对照组患者(24.66±1.26)(P<0.05)。术后24 h观察组患者丙二醛(MDA)水平(8.42±2.01)显著低于对照组患者(10.34±2.25)(P<0.05);术后24 h观察组患者超氧化物歧化酶(SOD)水平(89.35±18.31)显著高于对照组患者(76.47±17.95)(P<0.05)。术后24 h观察组外周血Keap1蛋白水平与对照组相比显著降低(P<0.05);术后24 h观察组外周血Nrf2蛋白水平与对照组相比显著升高(P<0.05)。观察组患者术后恢复指标时间与对照组相比均显著缩短(P<0.05)。与对照组(8%)相比,观察组患者并发症发生率(2%)下降,但两组之间无显著差异(P>0.05)。结论与全身麻醉相比,腰硬联合麻醉可激活Keap1-Nrf2抗氧化应激通路,抑制氧化应激并降低患者术后认知功能障碍风险,稳定患者血流动力学指标并加快患者术后恢复,安全性高,值得临床推广应用。
Objective To analyze the effect of combined spinal-epidural anesthesia in elderly patients with fracture and its influence on the activity of kelch like ECH associated protein 1(Keap1)-nuclear factor erythroid 2-related factor 2(Nrf2)signaling pathway.Methods Totally 100 elderly patients with fracture treated by orthopedic surgery were divided into control group(n=50)and observation group(n=50)by random number table method.The control group was given general anesthesia,and the observation group was given combined spinal-epidural anesthesia,the postoperative outcomes and Keap1-Nrf2 pathway activity of the two groups were compared.Results At 5 min(T_1)and 15 min(T_2)after anesthesia,compared with the control group,the heart rate(HR)in the observation group was lower and the average arterial pressure(MAP)was higher.At 24 h after operation,the MMSE score of the observation group(25.31±1.32)was higher than that of the control group(24.66±1.26)(P<0.05).At 24 h after operation,the malondialdehyde(MDA)in the observation group(8.42±2.01)was lower than that in the control group(10.34±2.25).and the level of SOD in the observation group(89.35±18.31)was higher than that in the control group(76.47±17.95)(P<0.05).At 24 h after operation,the Keap1 protein in the peripheral blood of the observation group was lower than that of the control group,and the Nrf2 protein level in the peripheral blood was higher than that of the control group(P<0.05).Compared with the control group,the postoperative recovery time of patients in the observation group was significantly shortened(P<0.05).And the incidence of complications in the observation group was lower(2%vs 8%)(P>0.05).Conclusion Combined spinal-epidural anesthesia can activate Keap1-Nrf2 antioxidant stress pathway,reduce the risk of stress reaction and postoperative cognitive impairment,and has a relatively stable hemodynamics for patients,which is beneficial to postoperative recovery,safe and worth popularizing.
作者
马婕妤
MA Jie-yu(Department of Anesthesiology,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou 450007,China)
出处
《医药论坛杂志》
2024年第20期2193-2197,2202,共6页
Journal of Medical Forum