依托咪酯对老年患者腹腔镜下结直肠癌术后早期认知功能及血浆皮质醇的影响

Effect of Etomidate on early cognitive function and plasma cortisol in elderly patients underwent laparoscopic colorectal cancer surgery

目的:探讨依托咪酯对老年患者腹腔镜下结直肠癌术后早期认知功能及血浆皮质醇的影响。方法选择拟择期全麻下行腹腔镜下结直肠癌手术的老年患者60例,按随机数字表法分为依托咪酯组(E组)和七氟醚组(S组),每组30例。E组使用依托咪酯全凭静脉麻醉,S组使用七氟醚吸入麻醉。分别于麻醉前3 min(T0)、插管后3 min(T1)、手术结束时(T2)、术后24 h(T3)、术后48 h(T4) 5个时点,抽取静脉血测定血浆皮质醇水平。记录术后7 d两组患者术后认知功能障碍(POCD)的发生情况。结果:与S组比较,T1、T2时点E组血浆皮质醇水平均明显降低(均P<0.05)。术后7 d,S组和E组POCD发生率分别为为20.7%(6/29)、17.9%(5/28),组间比较差异无统计学意义(P>0.05)。结论:依托咪酯全凭静脉麻醉用于老年患者腹腔镜下结直肠癌手术,降低了血浆皮质醇水平,不增加POCD的风险。

Objective: To investigate the effect of Etomidate on early cognitive function and plasma cortisol in elderly patients underwent laparoscopic colorectal cancer surgery. Methods: Sixty elderly patients underwent elective laparoscopic colorectal cancer surgery under general anesthesia were randomly divided into the Etomidate group( group E) and Sevoflurane group( group S),with 30 patients in each group. Group E received total intravenous anesthesia with Etomidate,and group S received inhalation anesthesia with Sevoflurane. The venous blood was collected,and the plasma cortisol levels were determined at 3 min before the anesthesia( T0),3 min after the intubation( T1),immediately after the operation( T2),24 h after the operation( T3),and 48 h after the operation( T4). The incidence of postoperative cognitive dysfunction( POCD) was recorded at 7 days after operation. Results: Compared with group S,the plasma cortisol levels in group E at T1 and T2 significantly decreased( all P<0.05). At 7 d after the operation,the incidence of POCD in S group and E group was 20. 7%( 6/29) and 17. 9%( 5/28),respectively,with no statistically significant difference between the two groups( P>0.05).Conclusion: Using Etomidate total intravenous anesthesia for laparoscopic colorectal cancer in elderly patients reduces plasma cortisol levels without increasing the risk of POCD.