摘要
目的评价右美托咪定对新辅助化疗结肠癌患者术后认知功能障碍(POCD)的影响。方法选取2020年6月至2021年12月深圳市人民医院择期行结肠癌根治术患者105例为研究对象,采用随机数字表法分对照组、新辅助化疗组和右美托咪定治疗组,每组35例。对照组术前未接受新辅助化疗,新辅助化疗组和右美托咪定治疗组术前均接受新辅助化疗。右美托咪定治疗组麻醉诱导前给予0.5μg/kg负荷量的右美托咪定,给药时间为15 min,随即持续输注0.5μg/(kg·h)右美托咪定,术毕前30 min停止输注。分别于术前1 d、术后1、3 d检测3组患者血液中TNF-α、IL-17、丙二醛(MDA)、S-100β水平及超氧化物歧化酶(SOD)活性。于术前1 d和术后7 d记录3组患者简易精神状态量表(MMSE)、数字符号替换测试(DSST)、数字广度(顺向)及数字广度(反向)测试的评分并计算POCD发生率。结果与对照组比较,新辅助化疗组患者术后1、3 d血液中TNF-α、IL-17、MDA、S-100β水平均升高,SOD活性均降低,术后7 d MMSE、DSST、数字广度(顺向)和数字广度(反向)测试评分均降低,术后7 d POCD发生率增加,差异均有统计学意义(均P<0.05);与新辅助化疗组比较,右美托咪定治疗组患者术后1、3 d血液中TNF-α、IL-17、MDA、S-100β水平均降低,SOD活性均升高,术后7 d MMSE、DSST、数字广度(顺向)和数字广度(反向)测试评分均升高,术后7 d POCD发生率降低,差异均有统计学意义(均P<0.05)。结论术前新辅助化疗导致结肠癌手术患者POCD发生率增加,而右美托咪定治疗可降低这些患者POCD发生率,其机制可能与其抑制炎性反应和氧化反应有关。
Objective To evaluate the effect of dexmedetomidine on post operative cognitive dysfunction(POCD)in colon cancer patients with neoadjuvant chemotherapy.Methods One hundred and five patients undergoing elective colon cancer surgery in Shenzhen People's Hospital from June 2020 to December 2021 were randomly divided into three groups with 35 cases in each group.Patients in control group(group C)did not receive preoperative neoadjuvant chemotherapy,while patients in neoadjuvant chemotherapy group(group N)and dexmedetomidine group(group D)received preoperative neoadjuvant chemotherapy;in group D,dexmedetomidine was given 0.5μg/kg in 15 min before anesthesia induction,followed by continuous infusion of 0.5μg/(kg·h)until 30 min before the end of operation.The general condition of each group was recorded.The levels of tumor necrosis factor-α(TNF-α),interleukin-17(IL-17),malondialdehyde(MDA),superoxide dismutase(SOD)and s-100βwere measured at 1 d before surgery(D0),1 d after surgery(D1)and 3 d after surgery(D_(3)).The mini-mental state examination(MMSE)test,digit symbol substitution test(DSST),digit span forward test and digit span backward test were performed D0 and 7 d after surgery(D_(7)).The incidence of POCD was calculated in the each group at D_(7).Results Compared with group C,the levels of TNF-α,IL-17,MDA and S-100βin group N were higher,and the SOD levels were lower at D1 and D_(3);the test scores of MMSE,DSST,DST(forward)and DST(back)were decreased at D_(7);the incidence of POCD was higher at D_(7)(all P<0.05).Compared with group N,the levels of TNF-α,IL-17,MDA and S-100βin group D were lower,and the SOD levels were higher at D1 and D_(3);the test scores of MMSE,DSST,DST(forward)and DST(back)were increased at D_(7);the incidence of POCD was lower at D_(7)(all P<0.05).Conclusion Preoperative neoadjuvant chemotherapy may increase the incidence of POCD in patients undergoing colon cancer surgery,while dexmedetomidine can reduced the incidence,which may be related to inhibiting inflammatory and oxidative r
作者
姜远旭
程静
张雪萍
JIANG Yuanxu;CHENG Jing;ZHANG Xueping(Department of Anesthesiology,Shenzhen People's Hospital(the First Affiliated Medical College,Southern University of Science and Technology),Shenzhen 518020,China)
出处
《浙江医学》
CAS
2023年第12期1287-1291,1303,共6页
Zhejiang Medical Journal
基金
深圳市人民医院临床研究/合作科研培育项目(SYLY201901)
深圳市医学重点学科建设经费资助项目(SZXK044)
深圳市“医疗卫生三名工程”资助项目(SZSM202011021)。
关键词
右美托咪定
化疗
术后认知功能障碍
肿瘤
Dexmedetomidine
Chemotherapy
Post operative cognitive dysfunction
Tumor
