七氟烷预处理和右美托咪定对老年食管癌患者术后认知功能的影响

目的比较七氟烷预处理和右美托咪定(DEX)对老年食管癌患者术后认知功能障碍(POCD)的影响,并探讨其可能机制。方法 120例老年食管癌手术患者按随机数字表法分成对照组、七氟烷组、DEX组、DEX+七氟烷组,每组30例。麻醉诱导前,对照组只给予吸氧,七氟烷组给予七氟烷预处理,DEX组给予DEX预处理,DEX+七氟烷组给予七氟烷预处理的同时给予DEX预处理。测定4组入室后、插管后及拔管时的心率(HR)及平均动脉压(MAP),术后48 h视觉模拟评分法(VAS)评分及术后1、3、7 d的POCD发生率,检测入室后、拔管后及术后l、3、7 d血浆S100β蛋白和神经元特异性烯醇化酶(NSE)的水平。结果入室后、插管后及拔管时2种麻醉药物对HR、MAP的影响均无交互作用(P>0.05);与对照组比较,七氟烷组仅插管后HR降低,DEX组及DEX+七氟烷组插管后及拔管时HR、MAP均降低(P<0.05),七氟烷组术后48 h镇痛满意和疼痛明显患者比例差异均无统计学意义;与对照组、七氟烷组比较,DEX组和DEX+七氟烷组镇痛满意患者比例增加,而疼痛明显患者比例降低(P<0.05)。...

Effects of sevoflurane preconditioning and dexmedetomidine on postoperative cognitivedysfunction in elderly patients with esophageal carcinoma

Objective To compare the effects of sevoflurane pretreatment and dexmedetomidine (DEX) onpostoperative cognitive dysfunction (POCD) in elderly patients with surgery for esophageal carcinoma, and to explore itspossible mechanism. Methods A total of 120 patients who underwent esophageal carcinoma were assigned to the followingfour groups (n=30 for each group): control group, sevoflurane group, DEX group and DEX+sevoflurane group. Beforeintravenous induction, control group accepted to inhale oxygen, sevoflurane group accepted to pretreat with sevoflurane, DEXgroup accepted to inhale oxygen and to pretreat with DEX, and DEX+sevoflurane group accepted to pretreat with sevofluraneand DEX. The heart rate (HR) and mean arterial pressure (MAP) before anesthesia administration, after the intubation andextubation were observed in the four groups. The 48 h VAS scores and POCD incidence at 1 d, 3 d and 7 d after operationwere compared between the four groups. The S100β and NSE protein concentrations were measured by ELISA beforeanesthesia administration，after extubation and the 1st, 3rd, and 7th postoperative days. Results There was no interactionbetween sevoflurane and DEX on HR and MAP during the experiment (P＞0.05). Compared with the control group, the HRdecreased in the sevoflurane pretreatment group only after the intubation (P＜0.05), and the HR and MAP decreased in DEXgroup after the intubation and at the time of extubation (P＜0.05). There was no significant difference in the proportion ofpatients with satisfactory and analgesia ratio in sevoflurane group 48 h after surgery (P＞0.05). Compared with the control group and sevoflurane group, the proportion of patients with satisfactory and analgesia ratio increased in Dex group andDex + sevoflurane group, while the proportion of patients with 4-10 scores decreased (P＜0.05). Compared with the controlgroup, the incidence of POCD one day after surgery was decreased in the sevoflurane group, the incidence of POCD 1 d and7 d after surgery was decreased in the DEX group, and the incidence of POCD 1 d, 3 d and 7 d after surgery was decreased inthe DEX+sevoflurane group (P＜0.05). There was no interaction between sevoflurane and DEX on serum S100β protein andNSE protein concentrations during the experiment (P＞0.05). The serum levels of S100β protein and NSE protein decreasedafter the extubation and 1 d, 3 d after operation in sevoflurane group compared with those of control group (P＜0.05). Theserum levels of S100β protein and NSE protein also decreased after the extubation and 1 d, 3 d and 7 d after operation inDEX group (P＜0.05). Conclusion Both sevoflurane and DEX pretreatment can inhibit the increased serum levels ofS100β and NSE protein in elderly patients after the surgery for esophageal carcinoma, thereby reducing the incidence ofPOCD. DEX is more effective, but the combined effect of the two drugs is not ideal.