摘要
目的 评价肢体缺血预处理对直肠癌根治术老年病人术后认知功能的影响.方法 择期行经腹直肠癌根治术病人80例,ASA分级Ⅰ-Ⅲ级,NYHA心功能分级Ⅰ-Ⅲ级,性别不限,年龄65～78岁,体重45 ～ 81 kg,采用随机数字表法,将其分为2组（n=40）：对照组（C组）和肢体缺血预处理组（R组）.静脉注射咪达唑仑、依托咪酯、舒芬太尼和顺苯磺酸阿曲库铵麻醉诱导,气管插管后行机械通气,维持PET CO235 ～ 45 mmHg.麻醉维持：静脉输注丙泊酚和瑞芬太尼,间断静脉注射顺苯磺酸阿曲库铵.术中维持BIS值40 ～ 60.R组用血压计袖带系于左下肢,球囊充气,维持袖带压力200mmHg,充气5 min后放气5 min,共循环3次行缺血预处理.术后采用舒芬太尼行自控静脉镇痛.分别于麻醉诱导前、术毕、术后1和7d时,抽取颈静脉球部血样,采用ELISA法测定血清S-100β蛋白浓度.记录术后7d时认知功能障碍（MMSE评分＜24分）的发生情况.结果 与C组比较,R组术毕、术后1和7d时血清S-100β蛋白浓度降低（P＜0.05）.2组POCD发生率均为17.9％,差异无统计学意义（P＞0.05）.结论 肢体缺血预处理可降低直肠癌根治术老年病人术后血S-100β蛋白浓度,但对POCD无改善.
Objective To evaluate the effect of lower extremity ischemic preconditioning on postoperative cognitive function in the elderly patients undergoing radical resection of rectal carcinoma.Methods Eighty ASA physical status Ⅰ-Ⅲ patients of both sexes,aged 65-78 yr,weighing 45-81 kg,undergoing elective radical resection of rectal carcinoma,were randomly divided into 2 groups （n =40 each）：control group （group C） and extremity ischemic preconditioning group （group P）.Anesthesia was induced with midazolam,etomidate,sufentanil and cisatracurium besylate.The patients were endotracheally intubated and mechanically ventilated.Anesthesia was maintained with iv infusion of propofol and remifentanil and intermittent iv boluses of cisatracurium besylate.BIS value was maintained at 40-60 during operation.The patients underwent three cycles of 5 min left lower extremity ischemia which was induced by a manual cuff-inflator placed on the left lower extremity and inflated to 200 mmHg,followed by 5 min deflation in group P.Patient-controlled intravenous analgesia with sufentanil was used for postoperative analgesia.Before induction,at the end of operation and at 1 and 7 days after operation,blood samples were collected from the jugular bulb for determination of serum S-100β concentrations using ELISA.Postoperative cognitive dysfunction （MMSE score 〈 24） at 7 days after operation was recorded.Results The serum S-100β concentration was significantly lower at the end of operation and 1 and 7days after operation in group P than in group C （P 〈 0.05）.The incidence of postoperative cognitive dysfunction in both groups was 17.9% and there was no significant difference between the two groups （P 〉 0.05）.Conclusion Lower extremity ischemic preconditioning can decrease blood S-100β concentrations,but it provides no improvement in postoperative cognitive dysfunction in elderly patients undergoing radical resection of rectal carcinoma.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2014年第1期12-14,共3页
Chinese Journal of Anesthesiology
关键词
缺血预处理
下肢
认知障碍
老年人
Ischemic preconditioning
Lower extremity
Cognition disorders
Aged
