地塞米松对胃肠肿瘤根治术老年患者术后早期认知功能的影响

目的观察术前应用地塞米松对老年胃肠肿瘤根治术患者术后早期认知功能的影响。方法选择本院2013年6月至2015年6月于全身麻醉下行胃肠肿瘤根治术的老年患者120例,男94例,女26例,年龄66~85岁,体重48~78kg,ASAⅠ~Ⅲ级。采用随机数字表法,将患者随机均分为两组:地塞米松组(D组)和生理盐水对照组(C组)。D组于术前1h静脉注射地塞米松10mg(稀释成2ml),C组静脉注射等容量生理盐水2ml。分别于术前1d、术后1、3、7d时行简易智能量表(MMSE)评分,术后评分低于术前1分以上确定有认知功能下降,则诊断为发生术后认知功能障碍(POCD)。并分别于上述时点采集患者血样测定血清神经元特异性烯醇化酶(NSE)、星形胶质源性蛋白(S100β)、IL~(-1)β、TNF-α、C反应蛋白(CRP)及皮质醇(Cor)浓度。结果 D组患者POCD发生率为9例(15.0%),明显低于C组的19例(31.7%)(P0.05)。与C组比较,D组患者术后1、3d时血清NSE、S100β、IL~(-1)β、TNF-α、CRP及Cor浓度明显降低(P0.05)。结论术前应用地塞米松可改善老年胃肠肿瘤根治术患者的POCD,其机制可能与其抑制炎性反应及Cor过度产生有关。

Effects of dexamethasone on early postoperative cognitive function in elderly patients undergoing radical operation for gastrointestinal cancer

Objective To investigate the effects of dexamethasone on early postoperative cogni-tive function in elderly patients undergoing radical operation for gastrointestinal cancer.Methods One hundred and twenty ASA Ⅰ-Ⅲ elderly patients aged 66-85 years,undergoing radical operation for gastrointestinal cancer were randomly divided into 2 groups (n = 60 each):dexamethasone group (group D)and control group (group C).Patients received 10 mg dexamethasone (2 ml)intravenously over 1 h before operation in group D.Group C received the equal volume of normal saline.The patients cognitive score was tested with mini-mental state examination (MMSE)at the time of 1l d preopera-tive,1 d,3 d and 7 d postoperative,as well as blood serum levels of neuron specific enolasel (NSE), S100β,IL-1β,TNF-α,C-reactive protein (CRP)and cortisol.Results The morbidity of POCD in group D was 9 (1 5.0%),it was significantly lower than 1 9 (31.7)% in group C (P <0.05).Com-pared with group C,serum levels of NSE,S100β,IL-1β,TNF-α,CRP and cortisol at 1 d and 3 d postoperative was significantly lower than that of group C (P <0.05 ),and there was no significant change 7 d postoperative in both groups.Conclusion Pretreatment with dexamethasone can improve early postoperative cognitive function in elderly patients undergoing radical operation for gastrointesti-nal cancer,and the mechanism may be associated with the inhibition of inflammatory response.