摘要
目的探讨麻醉深度对中老年患者术后认知程度、外周血炎性因子及细胞免疫功能的影响。方法回顾性分析2011年5月—2015年6月接受胃肠道手术的82例中老年患者的临床资料,按麻醉深度分为深麻醉组42例与浅麻醉组40例,深麻醉组术中脑电双频指数（BIS）值维持30-45,浅麻醉组BIS值维持45-60。两组均在麻醉诱导前（T0）、手术结束（T1）、术后1 d（T2）、术后2 d（T3）测定外周静脉血白介素-1β（IL-1β）、高迁移率族蛋白B1（HMGB1）、中枢神经特异蛋白（S100-β）及T淋巴细胞亚群（CD3＋、CD4＋和CD8＋）水平;术前、术后1 d和2 d均接受简易精神状态检查（MMSE）。结果术后1d、2d两组MMSE评分均低于术前（P〈0.05）,深麻醉组均高于浅麻醉组（P〈0.05）。深麻醉组术后1 d、2 d认知障碍发生率均低于浅麻醉组（P〈0.05）。T1时两组IL-1β水平高于T0、T2和T3（P〈0.05）。T2和T3时两组HMGB1水平高于T0（P〈0.05）,且深麻醉组T2和T3时低于浅麻醉组（P〈0.05）。T1时两组S100-β蛋白水平高于T0（P〈0.05）,T1、T2和T3时深麻醉组100-β蛋白水平低于浅麻醉组（P〈0.05）。T1、T2时两组CD3＋、CD4＋、CD8＋均低于T0（P〈0.05）,T3时两组仅CD3＋、CD4＋低于T0（P〈0.05）,T3深麻醉组CD3＋、CD4＋均高于浅麻醉组（P〈0.05）。结论深麻醉可降低中老年患者术后认知障碍发生率,缩短术后免疫功能恢复时间,减轻机体炎性反应。
Objective To investigate effects of anesthesia depth on cognition degree, inflammatory factors of pe-ripheral blood and cellular immune function in middle-aged and elderly patients after surgery. Methods Clinical data of 82 middle-aged and elderly patients underwent gastrointestinal surgery during May 2011 and June 2015 was retrospectively analyzed, and the patients were divided into deep anesthesia group （n=42） and shallow anesthesia group （n=40） ac-cording to anesthesia dept. Value of bispectral index （BIS） in deep anesthesia group was maintained at 30-45, and the value in shallow anesthesia group was maintained at 45-60. Levels of interleukin-1 beta （IL-1β）, high mobility group protein B1 （HMGB1）, central nervous of specific protein （S100-βprotein） and T lymphocyte subsets （CD3＋, CD4＋and CD8＋） of peripheral venous blood in two groups were determined before anesthesia induction （ T0 ） , at the end of surgery （T1）, 1 d after surgery （T2） and 2 d after surgery （T3）;all patients were examined by mini-mental state exam-ination （ MMSE） before surgery, 1 and 2 d after surgery. Results In two groups, MMSE scores were decreased 1 and 2 d after surgery compared with those before surgery （P〈0. 05）, and the score in deep anesthesia group was higher than that in shallow anesthesia group （P〈0. 05）. Incidence rates of cognitive disorder in deep anesthesia group 1 and 2 d af-ter surgery were lower than those in shallow anesthesia group （P〈0. 05）. In two groups, IL-1βlevels were increased at T1 compared with those at T0, T2 and T3 （P〈0. 05）. At T2 and T3, HMGB1 levels were increased compared with those at T0 in two groups （ P〈0. 05 ）; the levels in deep anesthesia group were lower than those in shallow anesthesia group （P〈0. 05）. At T1, in two groups, S100-βprotein levels were increased compared with those at T0 （P〈0. 05）. At T1, T2 and T3, S100-β protein levels in deep anesthesia group were lower than those in shallow anesthes
出处
《解放军医药杂志》
CAS
2016年第9期100-103,110,共5页
Medical & Pharmaceutical Journal of Chinese People’s Liberation Army
基金
陕西省卫生科研基金资助项目(2014E12)
关键词
麻醉
认知功能
脑电双频指数
炎症
Anesthesia
Cognition function
Bispectral index
Inflammation
