Effects of different anesthesia on S100β protein and postoperative cognitive dysfunction in elder patients undergoing colorectal cancer resection
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摘要: 目的 观察不同麻醉方式对老年直肠癌根治术患者术后早期认知功能障碍(postoperative cognitive dysfunction,POCD)和血清S100β蛋白水平的影响。 方法 选择年龄≥65岁,ASA Ⅰ~Ⅲ级,择期行直肠癌根治术的患者50例,根据所采用的麻醉方式不同,随机分为观察组和对照组,每组25例,观察组采用全身麻醉复合硬膜外麻醉,对照组采用单纯全身麻醉,2组患者全身麻醉诱导用药相同,并于麻醉前(T0)、术后2 h (T1)、术后24 h (T2)、术后48 h (T3)、术后72 h (T4)各时点检测血清S100β蛋白含量,记录各时点简易智力状态检查量表评分和POCD的发生率;同时观察2组患者麻醉时间、苏醒时间、拔管时间、苏醒期躁动发生例数、术中麻黄碱用量、舒芬太尼追加剂量。 结果 2组患者T1时POCD发生率均较高,组间比较差异无统计学意义(P>0.05),但在T2、T3和T4时点观察组POCD发生率明显低于对照组(P<0.05);T1和T2时点观察组血清S100β蛋白水平明显高于T0时(P<0.05),而对照组T1~T4各时点血清S100β蛋白水平均高于T0时(P<0.05)。观察组苏醒期时间及拔管时间明显短于对照组(P<0.05),苏醒期躁动发生率明显低于对照组(P<0.05),麻黄碱用量和舒芬太尼追加剂量明显多/少于对照组(P<0.05)。 结论 全身麻醉复合硬膜外麻醉用于老年患者直肠癌根治术时,可减少全麻药物使用剂量,降低早期POCD的发生率,提高了麻醉质量,血清S100β蛋白水平变化对预测早期POCD的发生有一定的意义。Abstract: Objective To observe the effects of different anesthesia on the level of S100β protein and postoperative cognitive dysfunction(POCD) in elder patients undergoing colorectal cancer resection. Methods Total 50 patients undergoing colorectal cancer resection,age ≥ 65,ASAⅠ-Ⅱ,were randomly divided into observed group(n=25) and control group(n=25) according to anesthesia methods.The observed group received general anesthesia combined with epidural anesthesia,while the control group received general anesthesia only;the two groups were taken the same general anesthesia medication but different drug concentration and dose in the anesthesia maintenance.The levels of serum S100β protein in the two groups at different time point(T0:before anesthesia,T1:2 h after surgery,T2:24 h surgery,T3:48 h after surgery,T4:72 h after surgery) were tested;The MMSE score,incidence of POCD,anesthesia time,recovery time,time to extubation,the number of awaken restlessness,the dose of Ephedrine and additional Sufentanil during the surgery,and the incidence of intraoperative awareness at each time point were recorded. Results The incidence of POCD were higher in the two groups at T1,the difference between the two groups was not statistically significant(P>0.05).But the incidence of POCD was significant lower in the observation group at T2,T3,and T4(P<0.05).The S100βprotein level at T1 and T2 were significantly higher than that at T0 in the observed group(P<0.05),while the S100β protein level at T1-T4 was higher than that at T0 in the control group(P<0.05).The time to recovery of consciousness and time to extubation in the observed group was significantly shorter than those in the control group(P<0.05),the incidence of awaken restlessness in the observed group was significantly lower than that in the control group(P<0.05),and the amount of Ephedrine and additional Sufentanil dose of observed group was significantly less than that in the control group(P<0.05). Conclusion The general anesthesia combined with epidural anesthesia for elder patients with colorectal cancer resection can reduce anesthesia drug dose and the incidence of early POCD,improve the quality of anesthesia.The changes of S100β protein levels have certain significance in predicting the occurrence of early POCD.
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Key words:
- Postoperative cognitive dysfunction /
- S100β protein /
- Anesthesia /
- Colorectal cancer /
- Elderly patients
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