摘要
目的探讨右美托咪定对老年腹腔镜胆囊切除术患者术后认知功能的影响。方法选取安徽省第二人民医院自2018年6月至2021年4月收治的124例拟行腹腔镜胆囊切除手术的老年患者为研究对象。随机将患者分为A组和B组,每组各62例。B组采用右美托咪定辅助麻醉;A组给予等容量生理盐水。比较两组患者术后1、3、7 d的认知功能障碍(POCD)发生率。比较两组患者术前及术后1、3、7 d的血清白细胞介素(IL)-1β、IL-18及单个核细胞(PBMCs)中NOD样受体蛋白3(NLRP3)mRNA、胱冬肽酶-1(Caspase-1)mRNA的表达情况。结果B组术后1、3、7 d的POCD发生率均低于A组,两组比较,差异有统计学意义(P<0.05)。两组患者术后1、3、7 d的IL-1β、IL-18水平均高于术前1 d,但B组低于A组,差异有统计学意义(P<0.05)。两组患者术后1、3、7 d的NLRP3 mRNA、Caspase-1 mRNA表达均高于术前1 d,且A组高于B组,差异有统计学意义(P<0.05)。结论右美托咪定可下调NLRP3 mRNA、Caspase-1 mRNA表达,抑制NLRP3/Caspase-1通路,降低血清IL-1β、IL-18水平,降低老年腹腔镜胆囊切除手术患者POCD发生风险。
Objective To investigate the effect of dexmedetomidine on the postoperative cognitive function of elderly patients undergoing laparoscopic cholecystectomy.Methods A total of 124 elderly patients undergoing laparoscopic cholecystectomy from June 2018 to April 2021 were selected as the research objects.The patients were randomly divided into group A and group B,with 62 cases in each group.Group B was given dexmedetomidine for auxiliary anesthesia,group A was given normal saline with equal volume.The incidence of postoperative cognitive dysfunction(POCD)were compared between the two groups at 1,3,and 7 days after surgery.The serum interleukin(IL)-1β,IL-18 and expression of NOD-like receptor protein 3(NLRP3)and Caspase-1(Caspase-1)in mononuclear cells(PBMCs)of patients before and 1,3,and 7 days after surgery were compared between the two groups.Results The incidence of POCD at 1,3,and 7 days after operation in group B were lower than those in group A,and the difference between the two groups were statistically significant(P<0.05).The levels of IL-1βand IL-18 of patients in two groups were lower than those of group A at 1,3,and 7 days after operation,and group B were lower than group A,the difference were statistically significant(P<0.05).The expressions of NLRP3 mRNA and Caspase-1 mRNA in the two groups of patients 1,3,and 7 days after operation were higher than those of the first day before operation,and group A were higher than group B,the difference were statistically significant(P<0.05).Conclusion Dexmedetomidine can down-regulate the expression of NLRP3 mRNA and Caspase-1 mRNA,inhibit the NLRP3/Caspase-1 pathway,reduce serum IL-1βand IL-18 levels,and reduce the risk of POCD in elderly patients undergoing laparoscopic cholecystectomy.
作者
江涛
汪平娟
王义桥
刘玉
俞学锋
梁向南
JIANG Tao;WANG Ping-juan;WANG Yi-qiao;LIU Yu;YU Xue-feng;LIANG Xiang-nan(Department of Anesthesiology,Anhui No.2 Provincial People's Hospital,Hefei 230001,China)
出处
《临床军医杂志》
CAS
2021年第8期880-882,886,共4页
Clinical Journal of Medical Officers
基金
安徽医科大学校科研基金项目(2019xkj246)
安徽省高校自然科学研究重点项目(kj2019A1111)。
