不同麻醉方法对老年胃肠手术患者 术后认知功能和外周血高迁移率族蛋白B1的影响

目的探讨不同麻醉方法对胃肠手术患者术后认知功能和外周血高迁移率族蛋白B1(HMGB-1)的影响。方法选取行腹腔镜胃肠手术的60例老年患者为研究对象,根据术中麻醉方法不同,将其随机分为联合组和对照组,每组30例。联合组术中采用全身麻醉复合硬膜外麻醉,对照组采用全身麻醉。比较2组围术期指标及不同时点血清HMGB-1水平、简易智力状态检查量表(MMSE)评分和术后认知功能障碍(POCD)发生情况。结果联合组拔管时间和苏醒时间均短于对照组,差异有统计学意义(P<0.05);联合组手术时间和术中出血量与对照组比较,差异无统计学意义(P>0.05)。2组T₁时点血清HMGB-1水平和MMSE评分比较,差异均无统计学意义(P>0.05)。联合组T₂时点血清HMGB-1水平高于T₁时点,MMSE评分低于T₁时点,差异有统计学意义(P<0.05);T₃时点,联合组血清HMGB-1水平和MMSE评分与T₁时点比较,差异均无统计学意义(P>0.05);对照组T₂和T₃时点血清HMGB-1水平高于T₁时点,MMSE评分低于T₁时点,差异有统计学意义(P<0.05)。联合组T₂和T₃时点血清HMGB-1水平均低于对照组,MMSE评分均高于对照组,差异有统计学意义(P<0.05)。联合组T₂和T₃时点POCD发生率均低于对照组,差异有统计学意义(P<0.05)。结论对行胃肠手术的老年患者应用全身麻醉复合硬膜外麻醉可尽快纠正外周血HMGB-1水平,有效降低术后POCD的发生率。

Effects of different anesthesia methods on postoperative cognitive function and high mobility group protein B1 for patients undergoing gastrointestinal surgery

Objective To investigate the effects of different anesthesia methods on postoperative cognitive function and high mobility group protein B1(HMGB-1)in peripheral blood of patients undergoing gastrointestinal surgeries.Methods A total of 60 elderly patients who underwent laparoscopic gastrointestinal surgeries were selected as the study objects.According to the different anesthesia methods used in the operation,they were randomly divided into two groups,with 30 cases in the combined group and 30 cases in the control group.General anesthesia combined with epidural anesthesia was used in the combined group,while general anesthesia was used in the control group.The perioperative indexes,level of serum HMGB-1 and Mini-mental State Examination(MMSE)scores at different time points,incidence of postoperative cognitive dysfunction(POCD)were compared between the two groups.Results The extubation time and recovery time of the combined group were significantly shorter than those of the control group(P<0.05),while there were no significant differences in operation time and bleeding volume between the two groups(P>0.05).At T₁,there were no significant differences between the two groups in serum HMGB-1 level and MMSE score(P>0.05);while the level of serum HMGB-1 at T₂ in the combined group was significantly higher than that at T₁,and MMSE score was significantly lower than that at T₁(P<0.05).There were no significant differences in HMGB-1 level and MMSE score between T₃ and T₁ in the combined group(P>0.05).The levels of serum HMGB-1 at T₂ and T₃ in the control group were significantly higher than those at T₁,and the MMSE score was significantly lower than that at T₁(P<0.05).The levels of serum HMGB-1 in the combined group at T₂ and T₃ were significantly lower than those in the control group,and the MMSE scores were significantly higher than those in the control group(P<0.05).The incidence rates of POCD in the combined group at T₂ and T₃ were significantly lower than those in the control group(P<0.05).Conclusion General anesthesia combined with epidural anesthesia for elderly patients undergoing gastrointestinal surgeries can correct the level of HMGB-1 in peripheral blood as soon as possible and reduce the incidence of POCD after surgeries.