七氟烷静吸复合右美托咪定麻醉对老年腹腔镜肿瘤切除术后认知功能及血清NGF、BDNF水平的影响.docx

七氟烷静吸复合右美托咪定麻醉对老年腹腔镜肿瘤切除术后认知功能及血清NGF、BDNF水平的影响黄代强袁静一孙静雪易姝彤赵雷深圳市人民医院(暨南大学笫二临床医学院)麻醉科，广东深圳51802()基金项目：深圳市科技创新委员会基础研究(项目编号：JCYJ200540)【摘要】目的，研究七氟烷静吸复合右美托咪定麻醉对老年腹腔镜肿瘤切除术后认知功能及血清神经生长因子(NGF)、脑源性神经营养因子(BDNF)水平的影响，为临床研窕提供指导方法t选取深圳市人民灰院于2018年9月-2020年9月收治的80例行腹腔镜肿搐切除术的老年患者进行研究，按照随机数表法分为观察组和对照组各40例。对照组行七班烷静吸麻醉，观察组行七氟烷静吸豆合右美托咪定麻醉。观察并比较两组患者麻醉前IOmin(To)、麻醉后10min_(Ti).手术中、手术后上宴)的心率和血氧饱和度，术中血压水平、出血量,术后苏醒时间、说话时间以及拔管时间,麻醉前、术后Id、3d、5d的简易智力状态检查量表(MMSE)评分和连线试验(TMT)完成时间情况，以及两组麻醉前、术后血清BDNF、NGF水平变化情况结果：两组患者的心率、血氧饱和度在T、T2时均较TO时明显升高，对照组心率、血氧饱和度在、T2时分别为(IO7.68±457)次/min、(98.45±0.39)%,(97.59±525)次/min、(98.01±0.39)%,均明显高于观察组的(102.09±4.69)次/min、(97.26±0.30)%、(92.I8±3.92)次/min、(96.73±().34)%,差异应具有统计学意义(P<005)：观察组患者术中收缩压、舒张压、术中出血量分别为(120.21±10.40)mmHg,(78.12±9.95)mmHgX(226.15±8.12)ml,明显低于对照组的(126.42±10.21)mmHg、(83.26±9.11)mmHg.(234.51±8.74)ml,苏醒时间、说话时间、拔管时间分别为(40.52±252)min、(110.17±12.10)min、(90.47±12.51)min,明显短于对照组的(46.77±2.13)min、(1I5.42±12.28)min、(99.56±12.12)min.差异均有统计学意义(P<0.05)：术后Id、3d,两组患者的TMT完成时间较麻醉前延长，对照组分别为(46.16±3.05)s、(44.84±2.64)s,明显长于观察组的(4432±2.68)$、(43.38±2.78)S,差异均有统计学意义(Pv().05):术后ld、3d,两组患者的MMSE评分较麻醉前降低,时照组分别为(24.92±1.69)分、(25.46±1.56)分，明显低于观察组的(25.91±1.37)分、(26.56±L36)分.差异均具有统计学意义(P<0.05):术后，观察组两组患者的血清BDNF、NGF水平分别为(23.62±5.48)pg/ml、(29.76±3.33)Dgml,均明显低于麻醉前的(24.31±5.51)Mml、(28.92±1.79)Dgml,对照组患者的血消BDNF、NGF水平分别为(24.31±551)DWm1、(2892±1.79)pgml,均明显低麻醉前的(29.22±5.43)pg/mk(32.60±L94)pgml,差异均有统计学意义(P<0.05),但两组观察组和对照组比较差异均无统计学意义(P>0.05)结论：七氟烷静吸复合右美托咪定麻醉应用于老年腹腔镜肿瘤切除术对患者的血流动力学影响较小,Jl可降低血清中NGF、BDNF含量，促进患者术后认知功能恢复。【关健词】肿瘤切除手术：麻醉药物：七版烷：右美托咪定：认知功能：神经生长因子；脑源性神经营养因子Effectofsevo11uraneinhalationcombinedwithdexmedetomidineanesthesiaoncognitivefunctionandserumNGFandBDNFlevelsafterlaparoscopictumorresectioninelderlypatientsHuangDaiqiang,YuanJing,sunJingxue,YiShutong,ZhaoLeiDepartmentofAnesthesiology,ShenzhenPeople'sHospital(SecondClinicalMedicalCollegeofJinanUniversity)518020AbstractObjective:TbstudytheeffectofSevofluraneinhalationcombinedwithdexmedetomidineanesthesiaoncognitivefunctionandserumSerumnervegrowthfactor(NGF),brain-dcrivcdneurotrophicfactor(BDNF)levelsafterlaparoscopiclumorresectioninelderlypatients,provideguidanceforclinicalresearch.Methods:80elderlypatientsundergoinglaparoscopictumorresectionfromSeptember2018toSeptember2020inDePartmenlOfAnCSlhCSiOIOMyCfShCnZhCnPeople'sHOSPilalwereselectedibrresearch,andtheyweredividedintoobservationgroupandcontrolgroupaccordingioIherandomnumberIablemelhod、Wilh40casesineachgroup.-Thecontrolgroupwasanesthetizedwithsevoflurane,andtheobservationgroupwasanesthetizedwithSevofluranecombinedwithdexmedetomidine.Theheartrateandbloodox,aenSaIUnIIiOnOfIheIWOgroupsOfDaIienlSIOminbeforeanesthesia(7,IOminafteranesthesia(T1).duringIhCOPeraIion(T2).andafterIhCOPCraIion(T".inlraoperalivcbloodPreSSUrCICVCLbloodloss,DoSIoDeraIiVerecoverytime,SPeeChIimeandexlubaionlime,MMSESCoreandConneC【ion【e$l(TMT)COmPIelionUmebeforeane$he$iaandId,3d,5dafleraneshesia.andChanaeSinSerUmBDNFandNGFlevelsbeforeandafteranesthesiawereobseredandts:TheheartrateandbloodoxygensaturationofthetwogroupswereSignifiCantIyhigheratTiandTzthanatTo.theheartrateandbloodoxygensaturationofthecontrolgroupwere(IO7.68±4.57)beats/minand(98.45±0.39)%,(97.59±5.25)times/min,(98.01±0.39)%.which-awereSignifkanlIyhigherthantheobservationgroup(102.09±4.69)times/min,(97.26±0.30)%.(92.18±3.92)times/min,(96.73±0.34)%,thedifferencewasstatisticallysignificant(P<0.05)theiniraoDeraliveSVStoliCbloodDreSSUre,diastolicbloodDreSSUre,andintraoperativebloodlossintheobservationgroupwere(120.21±10.4()mmHg,(78.12±9.95)mmHg,and(226.I5±8.12)ml,whichweresignificantlylowerthanthoseofthecontrolgroup(126.42±IO.21)mmHg,(83.26±9.11)mmHg,and(234.51±8.74)ml.thewake-uptime,speakinglime,andextubationtimewere(40.52±2.52)min,(1IO.I7±12.1O)min,(90.47±l2.5l)min,whichweresignificantlyshorterthanthecontrolgroup(46.77±2.13)min.(115.42±12.28)min,(99.56±12.12)min,thedifferencewasstatisticallysignificant(P<0.()5);Aal1and3daysafteroperation,thecompletiontimeofTMTinthetwogroupswcrclongerthanthatbeforeanesthesia,thecont11)lgroupwere(46.16±3.05)sand(44.84±2.64)s,whichweresignificantlylongerthantheobservationgroup's(44.32±2.68)Sand(43.38±2.78)s1IhedifferencesWereSIaliSliCaHySignifiCanl(P<0,05)al1and3daysafierOPeralion,IheMMSESCorCSOfIhCIWogroupsWerClowerIhanIhKSCbcfbrcanesthesia.IhCSCOrCSinIhKCOnlrOlgroupWere(24.92±1.69)and(25.46±l.56).WhiChWereSignifiCanuylowerIhanIhOSeinIheObSerVaUOngroup(25.91±1.37)and(26.56).±1.36)POinIS.lhdifferencesWCrCSlaIiSliCUHySignifiCanl(P<0.05):AflerOperation,theserumBDNFandNGFIeVeISOftheObSerValiOngrouDWere(23.62±5.48)Dg/mland(29.76±3.33)pgml.WhiChWereSignifiCanuyIoWerIhanIhoSebeforeaneshesia(24.31±5.51)PgZmland(28.92).±1.79)pg/ml:IheSerUmBDNFandNGFICvdSOfPaIiKnhiinIhCConIlX)IgroupWere(24.31±5.51)Dg/mland(28.92±1.79)Dg/mJWhiChWereSignifiCanuYIOWerIhanlhOSebeforeaneslhesia(29.22±5.43)gml,(32.60L94)gml.IhedifferenceWaSSlaIiSIiCalIySignifiCanl(PvO.05，butthedifferencebetweentheobservationgrouDandthecontrolgr