摘要
目的对比观察闭环靶控输注下不同麻醉深度对老年手术患者术后认知功能及脂肪细胞因子和氧化应激反应的影响。方法选取2017年1月至2018年11月利津县第二人民医院收治的择期于闭环靶控输注下行全身麻醉手术的120例老年患者作为研究对象,按照随机数表法将其随机分为深麻醉组(70例)和浅麻醉组(50例),其中深麻醉组脑电双频指数(bispectral index,BIS)设置为40,浅麻醉组BIS值设置为50,对比观察两组患者术前及术后第1、7天蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)评分,血清脂联素、内脂素、丙二醛(malondialdehyde,MDA)水平及超氧化物歧化酶(superoxide dismutase,SOD)活性,并统计术后认知功能障碍(postoperation cognitive dysfunction,POCD)的发生率,分析MoCA评分与血清脂联素、内脂素、MDA水平及SOD活性的相关性。结果(1)术后第1天,两组患者MoCA评分均低于术前,与术前比较,P均<0.05,差异具有统计学意义,且深麻醉组患者MoCA评分明显高于浅麻醉组,两组对比,P<0.05,差异具有统计学意义;术后第7天,两组患者MoCA评分均回升至术前水平,与术前比较,P均>0.05,差异无统计学意义,且两组间对比,P>0.05,差异也无统计学意义。(2)术后7 d内,深麻醉组有8例(11.4%)患者出现POCD,浅麻醉组有13例(26.0%)患者出现POCD,两组对比,P<0.05,差异具有统计学意义。(3)术后第1天,两组患者血清脂联素水平均明显低于术前、血清内脂素水平均明显高于术前,与术前比较,P均<0.05,差异具有统计学意义,且深麻醉组患者血清脂联素水平高于浅麻醉组、血清内脂素水平低于浅麻醉组,两组对比,P均<0.05,差异具有统计学意义;术后第7天,两组患者血清脂联素及内脂素水平均有所回调,其中深麻醉组患者两者均回调至术前水平,与术前比较,P均>0.05,差异无统计学意义,浅麻醉组患者血清脂联素水平仍低于术前、血清内脂素水平仍高于术前,与术前比较,P均<0.05,差异具有统计学意义,且两组间血清脂联素水平对比,P>0.05,差异无统计学意义,血清内脂素水平对比,P<0.05,差异具有统计学意义。(4)术后7 d内,两组患者血清SOD活性均呈先降低后回升的趋势,而MDA水平则呈先升高后回落的趋势(P均<0.05),两组患者各时间点血清SOD活性及MDA水平组内两两对比,P均<0.05,差异具有统计学意义。术后第1天,深麻醉组患者血清SOD活性高于浅麻醉组、MDA水平低于浅麻醉组,两组对比,P均<0.05,差异具有统计学意义;术后第7天,深麻醉组患者SOD活性与浅麻醉组患者基本持平,两组对比,P>0.05,差异无统计学意义,而MDA水平则低于浅麻醉组,两组对比,P<0.05,差异具有统计学意义。(5)术后MoCA评分与血清脂联素水平及SOD活性呈显著正相关,与血清内脂素及MDA水平呈显著负相关。结论在闭环靶控输注下对老年手术患者选择适度深麻醉,可在一定程度上降低POCD的发生率,有利于患者的术后康复,这一作用机制可能与其能够调节脂肪细胞因子水平以及氧化应激反应程度有关,有待进一步深入研究验证。
Objective To compare and observe the effect of different anesthesia depths under the closed loop tar get controlled infusion on postoperative cognitive function,adipocytokines and oxidative stress of elderly patients.Methods A total of 120 elderly patients who underwent operations under the closed loop target controlled infusion for gen eral anesthesia in Lijin Second People’s Hospital from January 2017 to November 2018 were selected as subjects to be di vided,according to the random number table,into deep anesthesia group(70 cases)and light anesthesia group(50 ca ses).The bispectral index(BIS)of the patients in the deep anesthesia group was set at 40,and the BIS value of the pa tients in the light anesthesia group was set at 50.Montreal cognitive assessment(MoCA)score,serum adiponectin,visfa tin,malondialdehyde(MDA)levels and superoxide dismutase(SOD)activity were observed and compared between the two groups at the time points of before the operation and on day 1 and 7 postoperation.And the incidence of postoperative cogni tive dysfunction(POCD)was also recorded,and the correlation between MoCA score and serum adiponectin,visfatin,MDA level and SOD activity were analyzed.Results(1)On day 1 postoperation,the MoCA scores in the two groups were both lower than that before the operation and the differences were statistically significant(P<0.05).The MoCA score in the deep anesthesia group was significantly higher than that in the light anesthesia group and the difference was also statis tically significant(P<0.05).On day 7 postoperation,the MoCA scores in the two groups rose back to their preoperative levels,and no statistically significant difference can be observed(P>0.05),and the between group comparison of MoCA score on day 7 postoperation also showed no statistically significant difference(P>0.05).(2)Within 7 days postopera tion,there were respectively 8 patients(11.4%)and 13 patients(26.0%)in the deep anesthesia group and the light an esthesia group developed POCD,and the difference showed statistically significance(P<0.05).(3)On day 1 postopera tion,the serum adiponectin levels in the two groups were significantly lower than their respective preoperative levels and the serum visfatin levels were significantly higher than their respective preoperative levels,and the differences were both statisti cally significant(P<0.05).The serum adiponectin level in the deep anesthesia group was higher than that in the light an esthesia group and the serum visfatin level in the deep anesthesia group was lower than that in the light anesthesia group,and the differences between the two groups were statistically significant,both P<0.05.On day 7 postoperation,the levels of serum adiponectin and visfatin both returned to their previous levels a little bit in the two groups.In the deep anesthesia group,the levels of the two items returned to their respective preoperative levels and no statistically significant difference can be observed as compared with their respective preoperative levels,both P>0.05.However,on day 7 postoperation in the light anesthesia group,the serum adiponectin level was still lower than its preoperative level,and the serum visfatin level was still higher than its preoperative level,and the differences were both statistically significant(P<0.05).The between group comparison of serum adiponectin level on day 7 postoperation showed no statistically significant difference(P>0.05)while the between group comparison of serum visfatin level on day 7 postoperation showed statistically significant difference(P<0.05).(4)Within 7 days postoperation,the serum SOD activity in the two groups decreased first and then increased,while the MDA level increased first and then decreased,and the differences were both statistically significant(P<0.05).The serum SOD activity and MDA level were compared within each of the two groups at different time points and the results all showed statistically significant difference(P<0.05).On day 1 postoperation,the serum SOD activity in the deep anes thesia group was higher than that in the light anesthesia group,and the MDA level was lower than that in the light anesthesia group,and the comparison of the two items between the two groups showed statistically significant difference(both P<0.05).On day 7 postoperation,the SOD activity in the deep anesthesia group was basically the same as that in the light an esthesia group,and no statistically significant difference was observed between the two groups(P>0.05).The MDA level in the anesthesia group was lower than that in the light anesthesia group,and the between group difference of MDA level was statistically significant(P<0.05).(5)Positive correlation existed between postoperative MoCA score and serum adiponec tin level&SOD activity,while negative correlation existed between postoperative MoCA score and serum visfatin&MDA levels.Conclusions Choosing deep anesthesia under the closed loop target controlled infusion appropriately for elderly pa tients who needs operation can reduce their incidence of POCD to some extent and is good for patients’postoperative reha bilitation,of which the mechanism of action may be related to its ability of regulating the level of adipocytokines and oxida tive stress degree,but further research is needed to verify this assumption.
作者
潘敏敏
薄树春
杨文东
盖俊华
Pan Minmin;Bo Shuchun;Yang Wendong;Guo Junhua(Anesthesiology Departmen,Lijin Second People’s Hospital,Dongying City,Shandong 257447,China;Clinical Lab and Pathology Department,Lijin Second People’s Hospital,Dongying City,Shandong 257447,China;Gynaecology and Obstetrics Department,Dongying Second People’s Hospital,Dongying City,Shandong 257335,China;General Surgery Department,Dongying Second People’s Hospital,Dongying City,Shandong 257335,China)
出处
《中国烧伤创疡杂志》
2019年第5期351-357,共7页
The Chinese Journal of Burns Wounds & Surface Ulcers
关键词
闭环靶控输注
麻醉深度
老年
术后认知功能障碍
脂肪细胞因子
氧化应激
Closed loop target controlled infusion
Anesthesia depths
Elderly
Postoperative cognitive dysfunc tion
Adipocytokines
Oxidative stress
