2018 年第 12 期 第 13 卷

静吸复合麻醉与瑞芬太尼和丙泊酚复合全凭静脉麻醉对老年肺部肿瘤开胸手术患者术后认知功能的影响

Effects of intravenous-inhalation combined anesthesia and remifentanil plus propofol total intravenous anesthesia on postoperative cognitive function in elderly patients undergoing thoracotomy for lung tumor

作者：曾丽蓉郭瑞许锦雄金亮

英文作者：

单位：528415广东省中山市，南方医科大学附属小榄医院麻醉科

英文单位：

关键词：肺肿瘤；全凭静脉麻醉；静吸复合麻醉；开胸手术；认知功能

英文关键词：

• 摘要：

• 【摘要】目的    探讨静吸复合麻醉与瑞芬太尼、丙泊酚复合全凭静脉麻醉对老年肺部肿瘤开胸手术患者术后认知功能的影响。方法    选取2015年1月至2017年12月在南方医科大学附属小榄医院接受开胸手术的老年肺部肿瘤患者132例，应用随机数字表法将其分为静吸复合麻醉组（对照组）与瑞芬太尼、丙泊酚复合全凭静脉麻醉组（观察组），各66例，2组患者麻醉诱导方案相同。分别于麻醉前30 min（T0）、麻醉后12 h（T1）、麻醉后24 h（T2）采用简易精神状况检查量表（MMSE）评估2组患者的认知功能状态。并于上述时点采集2组患者的外周静脉血，采用放射免疫法检测认知功能损伤指标血清β淀粉样蛋白（Aβ）、神经元特异性烯醇化酶（NSE）、胰岛素样生长因子1（IGF-1）及氨基酸类神经递质谷氨酸、天冬氨酸、γ-氨基丁酸的含量。结果    T0时点2组患者MMSE评分和认知功能损伤指标以及氨基酸类神经递质水平比较差异均无统计学意义（均P＞0.05）。T1、T2时点，2组MMSE评分和血清IGF-1水平均低于T0，但观察组高于对照组［MMSE评分:（24.0±2.3）分比（22.8±2.1）分，（26.1±3.1）分比（24.6±3.3）分;血清IGF-1:（101±13）ng/L比（86±9）ng/L，（110±13）ng/L比（96±11）ng/L］；血清Aβ、NSE水平均高于T0，而观察组低于对照组［血清Aβ:（102±13）ng/L比（124±15）ng/L,（92±10）ng/L比（105±13）ng/L;血清NSE:（9.9±1.2）μg/L比（11.6±1.8）μg/L,（8.4±1.0）μg/L比（9.1±1.0）μg/L］，差异均有统计学意义（均P＜0.05）。T1、T2时点，2组患者血清γ-氨基丁酸水平低于T0，但观察组高于对照组；血清谷氨酸、天冬氨酸水平均高于T0，而观察组低于对照组，差异均有统计学意义（均P＜0.05）。结论    老年肺部肿瘤开胸手术患者接受瑞芬太尼、丙泊酚复合全凭静脉麻醉对患者术后认知功能造成的损伤轻于静吸复合麻醉。

• 【Abstract】Objective    To explore the effect of intravenous-inhalation combined anesthesia and remifentanil plus propofol total intravenous anesthesia on postoperative cognitive function in elderly patients undergoing thoracotomy for lung tumor. Methods    A total of 132 elderly patients with lung tumor undergoing thoracotomy in Siu Lam Hospital Affiliated to Southern Medical University during January 2015 to December 2017 were randomly divided into control group and observation group, with 66 cases in each group. Both groups had same anesthesia induction scheme. The control group had intravenous-inhalation combined anesthesia. The observation group had total intravenous anesthesia with remifentanil and propofol. At 30 min before anesthesia(T0), 12 h after anesthesia(T1) and 24 h after anesthesia(T2), cognitive function was assessed by Mini-Mental State Examination（MMSE）; serum contents of cognitive impairment indexes such as β-amyloid（Aβ）, neuronspecific enolase（NSE）, insulin-like growth factor-1（IGF-1） and amino acid neurotransmitters such as glutamic acid, asparagic acid andγ-aminobutyric acid were tested by radioimmunoassay. Results    There were no significant differences of MMSE score, cognitive impairment indexes and amino acid neurotransmitters between groups(P>0.05). At T1 and T2, MMSE score and serum IGF-1 level in both groups were significantly lower than those at T0; MMSE score and serum IGF-1 level in observation group were significantly higher than those in control group［MMSE score: （24.0±2.3） vs （22.8±2.1）, （26.1±3.1） vs （24.6±3.3）; IGF-1: （101±13）ng/L vs （86±9）ng/L, （110±13）ng/L vs （96±11）ng/L］; serum contents of Aβ and NSE were significantly higher than those at T0; serum contents of Aβ and NSE in observation group were significantly lower than those in control group［Aβ: （102±13）ng/L vs （124±15）ng/L, （92±10）ng/L vs （105±13）ng/L; NSE: （9.9±1.2）μg/L vs （11.6±1.8）μg/L, （8.4±1.0）μg/L vs （9.1±1.0）μg/L］（all P＜0.05）. At T1 and T2, serum content ofγ-aminobutyric acid was significantly lower and the contents of glutamic acid and asparagic acid were significantly higher than those at T0; γ-aminobutyric acid level in observation group was significantly higher, glutamic acid and asparagic acid levels were significantly lower than those in control group（all P＜0.05）. Conclusion    Remifentanil plus propofol total intravenous anesthesia has less damage on cognitive function than intravenous-inhalation combined anesthesia in elderly patients undergoing lung tumor thoracotomy.