本文關(guān)鍵詞： 加速康復(fù)外科 肝切除術(shù) 術(shù)后認(rèn)知功能　出處：《臨床麻醉學(xué)雜志》2016年07期 　論文類型：期刊論文

【摘要】：目的探討加速康復(fù)外科(ERAS)策略對肝切除術(shù)患者術(shù)后早期認(rèn)知功能的影響。方法篩選96例原發(fā)性肝癌擇期行肝部分切除術(shù)患者,隨機(jī)分為兩組,每組48例。C組實(shí)施常規(guī)圍術(shù)期處理及麻醉方法,ERAS組實(shí)施ERAS策略對圍術(shù)期處理及麻醉方法進(jìn)行優(yōu)化。于術(shù)前1d(T0)、術(shù)后1d(T4)、3d(T5)、7d(T6)應(yīng)用簡易智能量表(MMSE)評估兩組患者認(rèn)知功能,于T0、術(shù)后30min(T1)、6h(T2)、12h(T3)、T4取患者靜脈血檢測血清S100β蛋白、神經(jīng)元特異性烯醇化酶(NSE)含量和IL-1β、IL-6及TNF-α表達(dá)量。結(jié)果與C組比較,T4、T5時(shí)ERAS組MMSE評分明顯升高,T1、T2時(shí)S100β蛋白、IL-1β、IL-6明顯降低,T2、T3時(shí)NSE明顯降低,T1~T3時(shí)TNF-α明顯降低(P0.05)。與T0時(shí)比較,T4、T5時(shí)C組患者M(jìn)MSE評分明顯降低,T4時(shí)ERAS組MMSE評分明顯降低(P0.05)。兩組T1~T3時(shí)S100β蛋白明顯升高,T2~T4時(shí)NSE含量明顯升高,T1~T4時(shí)IL-1β、IL-6、TNF-α表達(dá)量均明顯升高(P0.05)。結(jié)論 ERAS策略應(yīng)用于肝癌肝切除術(shù)患者可改善患者術(shù)后認(rèn)知功能,其機(jī)制可能與降低患者術(shù)后血清中S100β蛋白、NSE、IL-1β、IL-6及TNF-α的含量有關(guān)。
[Abstract]:Objective to investigate the effect of accelerated rehabilitation surgery (ERASS) strategy on early cognitive function after hepatectomy. Methods 96 patients with primary liver cancer undergoing selective partial hepatectomy were randomly divided into two groups. Each group (n = 48) received routine perioperative management and anesthesia was performed with ERAS strategy in group ERAS. The perioperative management and anesthesia methods were optimized 1 day before operation. MMSE was used to evaluate the cognitive function of the two groups at T0 and 30 min after operation. Serum S100 尾 protein, neuron-specific enolase (NSE) content and IL-1 尾 were measured by 12 h T3 + T4. Results compared with group C, the MMSE score of ERAS group was significantly higher than that of group C at T _ 1 T _ 2 and T _ 1 / T _ 2. Results compared with group C, the MMSE score of ERAS group was significantly higher than that of group C at T _ 1 and T _ 2. IL-6 significantly decreased T _ 2T _ 3, NSE significantly decreased T _ 1 and T _ 3, TNF- 偽 significantly decreased P _ (0.05), compared with T _ (0) T _ (4). The MMSE score of group C was significantly lower than that of group C at T 5. The MMSE score of group ERAS was significantly lower than that of group ERAS at T 4. The S100 尾 protein increased significantly at T 1 and T 3 in both groups. The content of NSE increased significantly at T2T4 and IL-1 尾 -IL-6 at T1T4. The expression of TNF- 偽 was significantly increased (P 0.05). Conclusion ERAS strategy can improve postoperative cognitive function in patients with liver cancer after hepatectomy. The mechanism may be related to the decrease of serum S100 尾 protein, IL-1 尾, IL-6 and TNF- 偽 levels.
【作者單位】： 南昌大學(xué)第二附屬醫(yī)院麻醉科;
【基金】：國家自然科學(xué)基金(81560193)
【分類號】：R614
【正文快照】： 術(shù)后認(rèn)知功能障礙(POCD)是常見的麻醉并發(fā)癥之一,肝癌患者具有其自身的特殊性,在肝切除術(shù)后患者的POCD發(fā)生率可能更高[1,2],主要表現(xiàn)為精神錯(cuò)亂、焦慮、人格的改變以及記憶受損,同時(shí)伴有社交能力及認(rèn)知能力的改變,嚴(yán)重影響治療效果和患者的術(shù)后生活質(zhì)量[3]。加速康復(fù)外科(ERAS

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