摘要
目的:探讨七氟烷吸入全麻对全髋关节置换术(THR)老年患者血清白细胞介素-6(IL-6)、脑损伤蛋白S100β水平及凝血功能的影响。方法:选取2017年5月~2019年5月于本院行全髋关节置换术患者84例,年龄60~75岁,随机分为A组和B组各42例,A组给予七氟烷吸入全麻维持,B组给予丙泊酚全凭静脉麻醉维持。比较两组手术相关指标,术后并发症发生情况,手术前后血清IL-6、S100β水平、凝血功能指标[血小板计数(PLT)、纤维蛋白原(FIB)、血浆D-二聚体(D-D)、活化部分酶血活酶时间(APTT)、凝血酶原时间(PT)]、简易精神状态量表(MMSE)评分及蒙特利尔认知评估量表(MoCA)评分。结果:两组麻醉时间、手术时间、术中出血量及术后引流量比较,差异无统计学意义(P>0.05)。术后1 h、1 d及7 d,A组PLT、D-D及FIB水平均明显低于B组(P<0.05),PT及APTT明显高于B组(P<0.05)。术后1 h、1 d及7 d,A组血清IL-6、S100β水平均明显低于B组(P<0.05)。术后1 d,B组MMSE评分及MoCA评分均低于A组(P<0.05)。A组术后下肢深静脉血栓及认知功能障碍发生率低于B组(P<0.05)。结论:七氟烷麻醉能够降低老年THR患者术后下肢深静脉血栓及认知功能障碍的发生率,稳定患者凝血指标,下调IL-6及S100β的表达。
Objective:To investigate the effects of sevoflurane inhalation general anesthesia on serum IL-6,brain injury protein S100βand coagulation function in elderly patients undergoing total hip arthroplasty.Method:From May 2017 to May 2019,84 patients aged 60-75 years underwent total hip arthroplasty in our hospital were randomly divided into two groups:group A(n=42)and group B(n=42).Group A was maintained with sevoflurane inhalation by general anesthesia and group B with protocol by intravenous anesthesia.The surgical related indexes and postoperative complications in the two groups were compared.The level of serum IL-6,S100β,coagulation function index[platelet count(PLT),Fibrinogen(FIB),plasma D-dimer(D-D),activated partial enzyme activity time(APTT),prothrombin time(PT)],MMSE score and MoCA score were compared between two groups before and after operation.Results:There was no significant difference in anesthesia time,operation time,intraoperative bleeding and postoperative drainage(P>0.05).At 1 h,1 d and 7 d after operation,the level of PLT,D-D and FIB in group A were significantly lower than that in group B(P<0.05),PT and APTT were significantly higher than that in group B(P<0.05).At 1 h,1 d and 7 d after operation,the level of IL-6,S100βin group A were significantly lower than that in group B(P<0.05).At 1 d after operation,the MMSE and MoCA scores in group B were significantly lower than those in group A(P<0.05).The incidence of lower extremity deep venous thrombosis and cognitive impairment(2.38%)in group A was lower than that in group B(P<0.05).Conclusions:Sevoflurane anesthesia can reduce the incidence of deep venous thrombosis and cognitive impairment of the lower extremity after operation in elderly patients with THR,stabilize the coagulation index of patients,and downregulate the expression of il-6 and S100β.
作者
吴敏
刘荣
肖金辉
夏树红
王敏华
彭明
WU Min;LIU Rong;XIAO Jin-hui;XIA Shu-hong;WANG Min-hua;PENG Ming(Department of Anesthesiology, United Logistics Service 908 Hospital (Former People's Liberation Army 184 Hospital), Yingtan 335000, China)
出处
《海南医学院学报》
CAS
2020年第18期1400-1404,共5页
Journal of Hainan Medical University
基金
鹰潭市科技计划项目(YKz20180033)。
