麻醉深度对中老年胃肠道手术患者术后认知程度、外周血炎性因子及细胞免疫功能的影响

目的：探讨麻醉深度对中老年患者术后认知程度、外周血炎性因子及细胞免疫功能的影响。方法回顾性分析2011年5月—2015年6月接受胃肠道手术的82例中老年患者的临床资料,按麻醉深度分为深麻醉组42例与浅麻醉组40例,深麻醉组术中脑电双频指数(BIS)值维持30~45,浅麻醉组BIS值维持45~60。两组均在麻醉诱导前(T0)、手术结束(T1)、术后1 d(T2)、术后2 d(T3)测定外周静脉血白介素-1β(IL-1β)、高迁移率族蛋白 B1(HMGB1)、中枢神经特异蛋白(S100-β)及T淋巴细胞亚群(CD3+、CD4+和CD8+)水平；术前、术后1 d和2 d均接受简易精神状态检查(MMSE)。结果术后1d、2d两组MMSE评分均低于术前(P<0．05),深麻醉组均高于浅麻醉组(P<0．05)。深麻醉组术后1 d、2 d认知障碍发生率均低于浅麻醉组(P<0．05)。 T1时两组IL-1β水平高于T0、T2和T3(P<0．05)。 T2和 T3时两组 HMGB1水平高于 T0(P <0．05),且深麻醉组 T2和 T3时低于浅麻醉组(P <0．05)。 T1时两组S100-β蛋白水平高于T0(P<0．05),T1、T2和T3时深麻醉组100-β蛋白水平低于浅麻醉组(P<0．05)。 T1、T2时两组CD3+、CD4+、CD8+均低于T0(P<0．05),T3时两组仅CD3+、CD4+低于T0(P<0．05),T3深麻醉组CD3+、CD4+均高于浅麻醉组( P<0．05)。结论深麻醉可降低中老年患者术后认知障碍发生率,缩短术后免疫功能恢复时间,减轻机体炎性反应。

Effects of Anesthesia Depth on Cognition Degree,Inflammatory Factors of Peripheral Blood and Cellular Im-mune Function in Middle-aged and Elderly Patients after Gastrointestinal Tract Surgery

Objective To investigate effects of anesthesia depth on cognition degree, inflammatory factors of pe-ripheral blood and cellular immune function in middle-aged and elderly patients after surgery. Methods Clinical data of 82 middle-aged and elderly patients underwent gastrointestinal surgery during May 2011 and June 2015 was retrospectively analyzed, and the patients were divided into deep anesthesia group (n=42) and shallow anesthesia group (n=40) ac-cording to anesthesia dept. Value of bispectral index (BIS) in deep anesthesia group was maintained at 30-45, and the value in shallow anesthesia group was maintained at 45-60. Levels of interleukin-1 beta (IL-1β), high mobility group protein B1 (HMGB1), central nervous of specific protein (S100-βprotein) and T lymphocyte subsets (CD3+, CD4+and CD8+) of peripheral venous blood in two groups were determined before anesthesia induction ( T0 ) , at the end of surgery (T1), 1 d after surgery (T2) and 2 d after surgery (T3);all patients were examined by mini-mental state exam-ination ( MMSE) before surgery, 1 and 2 d after surgery. Results In two groups, MMSE scores were decreased 1 and 2 d after surgery compared with those before surgery (P<0. 05), and the score in deep anesthesia group was higher than that in shallow anesthesia group (P<0. 05). Incidence rates of cognitive disorder in deep anesthesia group 1 and 2 d af-ter surgery were lower than those in shallow anesthesia group (P<0. 05). In two groups, IL-1βlevels were increased at T1 compared with those at T0, T2 and T3 (P<0. 05). At T2 and T3, HMGB1 levels were increased compared with those at T0 in two groups ( P<0. 05 ); the levels in deep anesthesia group were lower than those in shallow anesthesia group (P<0. 05). At T1, in two groups, S100-βprotein levels were increased compared with those at T0 (P<0. 05). At T1, T2 and T3, S100-β protein levels in deep anesthesia group were lower than those in shallow anesthesia group (P<0. 05). At T1 and T2, CD3+, CD4+ and CD8+ levels were decreased compared with those at T0 in two groups (P<0. 05). At T3, CD3+ and CD4+ levels were lower compared with those at T0 in two groups (P<0. 05). In deep anesthesia group, CD3+ and CD4+ levels at T3 were higher than those in shallow anesthesia group (P<0. 05). Con-clusion Deep anesthesia can reduce incidence rate of cognitive disorder, shorten postoperative recovery time of immune function and decrease inflammatory reactions in middle-aged and elderly patients after surgery.