不同剂量丙泊酚靶控输注对老年患者术后认知功能及炎性细胞因子的影响

摘要

目的：观察不同剂量丙泊酚靶控输注对老年患者术后认知功能及炎性细胞因子的影响，探索丙泊酚的最佳使用剂量并指导临床用药。方法将本院2014年6月至2015年6月收治的60例美国麻醉医师协会（ASA）Ⅰ～Ⅱ级行开腹胃癌根治术的老年患者随机分为低剂量组（1μg/ml）、中剂量组（3μg/ml）、高剂量组（5μg/ml），每组各20例。于麻醉诱导前（T0）、手术开始后4小时（T1）、术后24小时（T2）及术后48小时（T3）采集患者外周静脉血，采用酶联免疫吸附测定（ELISA）检测白细胞介素（IL）-1β、IL-6和肿瘤坏死因子-α（TNF-α）水平。于术前和术后第1天及第2天采用简易精神状态量表（MMSE）对患者进行神经精神功能测试。结果三组患者术前一般情况、术中情况比较差异均无显著性（P＞0.05）。中剂量组患者术后苏醒质量、MMSE评分和术后认知功能障碍（POCD）发生率与低剂量组和高剂量组比较差异均具有显著性（P＜0.05）。T1、T2和T3时间点，三组患者血清IL-1β、IL-6和TNF-α水平较T0时间点均显著升高（P＜0.05），且中剂量组患者血清IL-1β、IL-6和TNF-α水平均显著低于低剂量组和高剂量组（P＜0.05）；T3时间点中剂量组患者血清IL-1α、IL-6和TNF-α水平与T0时间点比较差异无显著性（P＞0.05）。结论老年患者开腹手术中使用中剂量丙泊酚对老年患者的认知功能影响更小，且更能减轻患者的炎性反应，值得临床应用。%ObjectiveTo observe the effect of different doses of propofol target controlled infusion on the cognitive function and inflammatory cytokines in elderly patients, and to explore the optimal dosage of propofol and to guide the clinical application.MethodFrom June 2014 to June 2015, 60 elderly patients with ASAⅠ~Ⅱunderwent open radical gastrectomy in our hospital were randomly divided into low dose group (1μg/ml), medium dose group (3 μg/ml), high dose group (5 μg/ml), 20 patients in each group. Before anesthesia induction (T0), 4 hours after the start of the operation (T1), 24 hours after operation (T2) and 48 hours after operation (T3), peripheral venous blood was collected, and ELISA were used to measure the levels of IL-1β, IL-6 and TNF-α, MMSE was used to test the mental function of patients with the ifrst day and the second day after operation.ResultThere was no signiifcant difference between the three groups before and during the operation (P>0.05). Compared with low dose group and high dose group, the recovery quality, MMSE score and POCD score of medium dose group were statistically signiifcant (P<0.05). At T1, T2 and T3 time point, the serum levels of IL-1β, IL-6 and TNF-α of the three groups were signiifcantly higher than T0 time point (P<0.05), and the serum levels of IL-1β, IL-6 and TNF-α of medium dose group were signiifcantly lower than low dose group and high dose group (P<0.05). At T3 time point, the serum levels of IL-1β, IL-6 and TNF-α of medium dose group had no signiifcant difference with T0 time point (P>0.05).ConclusionThe use of middle dose of propofol in the elderly patients with open surgery has less inlfuence on the cognitive function of the elderly patients, and can reduce the inlfammatory reaction, it is worthy of clinical application.