依达拉奉预处理对老年骨科手术患者炎症相关因子与术后早期认知功能障碍的影响

【摘要】 目的 观察依达拉奉预处理对老年骨科手术患者炎症相关因子反应及术后早期认知功能的影响,探讨其降低术后早期认知功能障碍(POCD)的可行性。方法〓选择择期全麻下行髋关节手术患者60例,年龄≥65岁,ASA评级Ⅰ~Ⅲ级。分为依达拉奉预注组(E组,n=30例)和对照组(C组,n=30例)。分别在麻醉诱导后(T1)、手术结束时(T2)、术后24小时(T3)经颈内静脉抽取静脉血,测定IL-6、IL-10、TNF-?琢,及检测S100-β蛋白。选用简易智能状态检查量表(MMSE)评估术前1天,术后第1天和术后第7天认知状态,术后MMSE评分较术前下降≥2分评定POCD发生。结果〓两组患者中,与T1比较,T2~T3的IL-6、IL-10、TNF-?琢、S100-β水平明显升高(P均<0.05)。与C组比较,T3时E组患者IL-6、TNF-?琢水平明显降低(P均<0.05);T2~T3时E组患者S100-β水平也明显降低(P<0.05,与C组比较)。两组患者中,与术前1天比较,术后第1天MMSE评分明显降低(P均<0.05)。与C组比较,E组术后第1天MMSE评分明显增高(P<0.05)。E组发生POCD有4例,明显少于C组的9例(P<0.05)。结论 依达拉奉预处理应用于老年骨科手术患者,能一定程度抑制炎症相关因子水平,减少术后早期认知功能障碍的发生。

Effects of edaravone pretreatment on inflammatory cytokines and early stage postoperative cognitive dysfunction in elderly patients undergoing orthopedic surgery

Objective To evaluate the effect of edaravone on inflammatory cytokines and early stage postoperative cognitive dysfunction in elderly patients undergoing orthopedic surgery. Methods Sixty patients (ASA I-Ⅲ) aged 65 and over, undergoing hip joint surgery under general anesthesia, were assigned to groups (n=30, each group), control group (group C) and edaravone group (group E). Group E was treated with 30 mg of edaravone plus 100 ml saline for administration of intravenous drip. Group C was use 100 ml normal saline alone. The venous blood samples were drawn after induction of anesthesia (T1), at the end of surgery (T2), 24 hours after surgery (T3). The levels of IL-6, IL-10, TNF-α and S100-β were measured. The cognitive function in all patients at 1 day before surgery and 1 day,7 days after surgery was assessed by using Mini- Mental State (MMSE) test. POCD was defined as the difference between preoperative and postoperative mean MMSE score decline ≥2 points. Results Compared with T1, the levels of IL-6, IL-10, TNF-α and S100-β at T2 and T3 were significantly increased (all P values <0.05). The levels of IL-6, TNF-α at T3 in group C, were significantly increased than that in group E (all P values <0.05). Compared with group C, The levels of S100-β in group E at T2 and T3 were significantly decreased (P<0.05, vs group C). Compared with 1 day before surgery, the MMSE score were significantly declined at 1 day after surgery (P<0.05). Compared with group C, the MMSE score were significantly increased in group E at 1 day after surgery (P<0.05). The occurrence rate of POCD in group E were lower than that of group C at 1 day after surgery (P<0.05). Conclusion To a certain extent, edaravone could impair inflammatory reaction and reduce the incidence of POCD in elderly patients undergoing orthopedic surgery.