本文選題：七氟醚 + 老年患者�。� 參考：《山東大學(xué)》2014年碩士論文

【摘要】：目的： 術(shù)后認(rèn)知功能障礙(postoperative cognitive dysfunction, POCD)是指麻醉手術(shù)后引起的神經(jīng)認(rèn)知功能紊亂,表現(xiàn)為性格改變、學(xué)習(xí)記憶能力下降及認(rèn)知能力異常等中樞神經(jīng)系統(tǒng)功能障礙,嚴(yán)重的可出現(xiàn)癡呆。這一麻醉手術(shù)后的并發(fā)癥常發(fā)生于術(shù)后數(shù)周或數(shù)月,少數(shù)人可長(zhǎng)期存在,可以影響患者的學(xué)習(xí)記憶、社會(huì)活動(dòng),給社會(huì)及家庭帶來(lái)沉重的負(fù)擔(dān)。近年來(lái),隨著人口的老齡化,經(jīng)歷麻醉和手術(shù)的病人中老年患者的比例在逐年升高,POCD的發(fā)病率也在逐年上升。因此,探討POCD的發(fā)病機(jī)制及防治措施具有重要經(jīng)濟(jì)社會(huì)意義。本文旨在探討七氟醚吸入麻醉下老年食管癌患者根治術(shù)后認(rèn)知功能的變化情況。 方法： 選擇我院(山東大學(xué)第二醫(yī)院)62-75歲ASA Ⅰ-Ⅱ級(jí)的老年食管癌患者60例,隨機(jī)分為七氟醚吸入麻醉組(S組)和對(duì)照組(Con組),每組患者30例。兩組患者入室后開(kāi)放靜脈通路,監(jiān)測(cè)無(wú)創(chuàng)血壓(NIBP).心率(HR)、脈搏血氧飽和度(Sp02)、心電圖(ECG)、呼氣末二氧化碳分壓(PETCO2)。麻醉誘導(dǎo)：長(zhǎng)托寧0.01-0.02mg/kg,咪達(dá)唑侖2-3mg,依托咪酯0.2-0.4mg/kg,舒芬太尼0.3-0.6μg/kg,苯磺順阿曲庫(kù)胺0.2-0.4mg/kg,及艾司洛爾0.2-0.4μg/mg。插管成功后接麻醉機(jī),調(diào)節(jié)呼吸參數(shù)：潮氣量(VT)8-10ml/kg,呼吸頻率(RR)10-12次份,PETCO235-40mm Hg。術(shù)中S組予1-1.3MAC七氟醚,而Con組予靶控輸注2～4u g/mL異丙酚維持麻醉,手術(shù)開(kāi)始時(shí)追加舒芬太尼5-10μ g,按需追加苯磺順阿曲庫(kù)胺。依腦電雙頻指數(shù)(BIS)、血流動(dòng)力學(xué)改變及手術(shù)刺激強(qiáng)度調(diào)整麻醉深度。術(shù)中BIS值維持在50～60,BP低于基礎(chǔ)值20%予以麻黃堿,高于基礎(chǔ)值20%予以降壓處理；HR低于50次/分給予阿托品處理。當(dāng)開(kāi)始縫合時(shí)停止七氟醚吸入和異丙酚靶控輸注。所有患者術(shù)后均應(yīng)用患者自控靜脈鎮(zhèn)痛(PCIA):諾揚(yáng)10mg加凱紛100mg,手術(shù)結(jié)束時(shí)給負(fù)荷量2mL,持續(xù)輸注2mL/h,自控量4mL,鎖定時(shí)間15min。 分別在TO(入室),T1(插管),T2(切皮開(kāi)腹時(shí)),T3(關(guān)腹縫皮時(shí))、T4(拔管)時(shí)間點(diǎn)記錄平均動(dòng)脈壓(MAP),心率(HR)。分別于手術(shù)開(kāi)始前,手術(shù)結(jié)束后1d,手術(shù)結(jié)束后5d抽取2-4m1靜脈血,用ELISA法測(cè)定血漿中IL-6、TNF-α、S-100β蛋白的濃度。記錄手術(shù)結(jié)束后自主呼吸恢復(fù)時(shí)間、輕喚睜眼時(shí)間及拔管時(shí)間。于術(shù)前1天訪視病人時(shí)測(cè)定一次簡(jiǎn)易智能量表MMSE和MoCA,術(shù)后5天、術(shù)后10天各測(cè)一次對(duì)認(rèn)知功能進(jìn)行評(píng)估。 結(jié)果： 1.兩組患者的術(shù)前一般情況的差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。 2.兩組患者不同時(shí)間點(diǎn)MAP、HR的比較,組內(nèi)比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),而組間同一時(shí)間點(diǎn)比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。 3.兩組患者自主呼吸恢復(fù)時(shí)間、睜眼時(shí)間、拔管時(shí)間比較差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。 4.兩組患者術(shù)后IL-6及S-100β蛋白的血漿濃度均較術(shù)前明顯增高(P0.05)。術(shù)后ldS組的IL-6的血漿濃度明顯高于Con組(P0.05)。術(shù)后5d的S組的S-100β蛋白的血漿濃度高于Con組,P0.05。 5.與術(shù)前基礎(chǔ)值比較,兩組患者術(shù)后第1或5天MMSE評(píng)分明顯下降(P0.05)。兩組患者術(shù)前MMSE評(píng)分比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),但S組術(shù)后第1或5天MMSE和MoCA評(píng)分均有明顯低于Con組(P0.05)。 結(jié)論： 七氟醚吸入麻醉可引起老年食管癌根治術(shù)患者術(shù)后早期認(rèn)知功能的降低,這可能與炎癥反應(yīng)和S-100β蛋白有關(guān)。。
[Abstract]:Objective:
Postoperative cognitive dysfunction (postoperative cognitive dysfunction, POCD) refers to neurocognitive dysfunction caused by anaesthesia, characterized by character change, decline in learning and memory and abnormal cognitive ability, and serious dementia. The postoperative complications often occur after the operation. For several weeks or months, a few people can exist for a long time, which can affect the learning and memory of the patients, social activities, and bring a heavy burden to the society and the family. In recent years, with the aging of the population, the proportion of the elderly patients undergoing anesthesia and surgery is increasing year by year, and the incidence of POCD is increasing year by year. Therefore, the pathogenesis of POCD is discussed. The purpose of this study is to explore the changes of cognitive function after radical resection of esophageal cancer in elderly patients under sevoflurane inhalation anesthesia.
Method:
60 cases of elderly esophageal cancer at the age of 62-75 years ASA I - II in our hospital (Second Hospital of Shandong University) were randomly divided into the sevoflurane inhalation anesthesia group (group S) and the control group (group Con), with 30 cases in each group. The two groups were open to the open vein after admission to monitor non invasive blood pressure (NIBP), heart rate (HR), pulse oxygen saturation (Sp02), electrocardiogram (ECG), end expiratory (ECG), and end of breath. Carbon dioxide partial pressure (PETCO2). Anesthesia induction: Chang toning 0.01-0.02mg/kg, midazolam 2-3mg, etomidate 0.2-0.4mg/kg, sufentanil 0.3-0.6 mu g/kg, benzenesonatracurium 0.2-0.4mg/kg, and esmolol 0.2-0.4 u g/mg. intubation after the success of the anesthesia machine, regulating the respiratory parameters: tidal volume (VT) 8-10ml/kg, respiratory frequency (RR) 10-12 copies Group S in ETCO235-40mm Hg. was given 1-1.3MAC sevoflurane, and group Con was administered by target controlled infusion of 2 ~ 4U g/mL propofol to maintain anaesthesia. At the beginning of the operation, sufentanil was added to 5-10 mu of sufentanil, and in accordance with the need to add benzonatracuramide, according to the bispectral index (BIS), hemodynamic changes and surgical stimulation intensity to adjust the depth of anesthesia. The value of BIS in the operation was maintained at 50~60, BP. Lower than 20% of base value given ephedrine, higher than the base value of 20% for depressurization; HR was lower than 50 to atropine treatment. Sevoflurane inhalation and propofol target infusion were stopped when the suture began. All patients were treated with intravenous analgesia (PCIA) after operation: noyang 10mg plus Kay 100mg, the load was 2mL, continuous infusion at the end of the operation. Note 2mL/h, control volume 4mL, lock time 15min.
The average arterial pressure (MAP) and heart rate (HR) were recorded at the TO (entrance), T1 (intubation), T2 (when the skin cut off the skin), and the time point of T4 (extubation). At the end of the operation, after the operation, 1D and 2-4m1 venous blood were extracted from 5D after the operation. The concentration of IL-6, alpha, and beta protein in plasma was measured by ELISA method. The time of respiration recovery, the time of eye opening and opening, and the time of extubation were measured. A simple intelligent scale MMSE and MoCA were measured at 1 days before the operation, and the cognitive function was assessed at the 5 day after the operation and 10 days after the operation.
Result:
1. there was no significant difference in the general condition between the two groups (P0.05).
2. the comparison of MAP and HR at different time points in the two groups was statistically significant (P0.05), but there was no significant difference between the groups at the same time point (P0.05).
3. there was no significant difference in spontaneous breathing recovery time, eye opening time and extubation time between the two groups (P0.05).
4. the plasma concentration of IL-6 and S-100 beta protein in the two groups was significantly higher than that before operation (P0.05). The plasma concentration of IL-6 in group ldS was significantly higher than that in group Con (P0.05). The plasma concentration of S-100 beta protein in group S after operation was higher than that in Con group.
5. compared with the preoperative basic values, the MMSE scores of the two groups were significantly decreased (P0.05) on first or 5 days after operation. There was no statistical difference between the two groups before operation (P0.05), but the MMSE and MoCA scores in the S group were significantly lower than those in the Con group (P0.05) at first or 5 days after operation.
Conclusion:
Sevoflurane inhalation anesthesia can cause early postoperative cognitive dysfunction in elderly patients undergoing radical resection of esophageal cancer, which may be related to inflammatory reaction and S-100 beta protein.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R614;R735.1

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