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目的评价七氟醚预处理对老年肝癌肝切除患者术后认知功能的影响。方法筛选60例原发性肝癌择期行肝部分切除术患者,性别不限,年龄65~75岁,体重45~81 kg,ASA分级Ⅱ或Ⅲ级,采用随机数字表法,将患者分为2组(n=30):对照组(C组)和七氟醚组(S组)。采用咪达唑仑-顺苯磺酸阿曲库铵-舒芬太尼-依托咪酯行麻醉诱导,气管插管后行机械通气,维持P_(ET)CO_235~45 mmHg。麻醉维持:静脉输注异丙酚、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。S组于切皮前吸入呼气末浓度相当于2%七氟醚20 min,随后予以10 min的洗脱期,C组仅给予纯氧,其他与S组相同。于术前1 d(T_0)、手术结束后1 d(T_1)、5 d(T_2)、7 d(T_3)采集右颈内静脉血样测定血清S-100β蛋白浓度,并于T_2、T_3时采用简易智能量表(MMSE)对患者进行认知功能测试,记录POCD的发生情况。结果与T_0时比较,T_1T_2时两组患者血清S-100β蛋白浓度均明显升高(P<0.05);与C组比较,T_1~T_3时S组血清S-100β蛋白浓度明显降低(P<0.05),T_3时S组患者血清S-100β蛋白浓度则基本恢复到T_0时,而C组仍高于T_0时。与T_0时比较,T_2时两组患者MMSE评分均明显降低(P<0.05)。与C组比较,T_2T_3时S组MMSE评分明显升高(P<0.05),T_3时S组MMSE评分则基本恢复到T_0时,而C组仍高于T_0时。C组和S组POCD发生率分别为26.7%和13.3%,C组高于S组(P<0.05)。结论七氟醚预处理可降低老年肝癌肝切除患者术后血S-100β蛋白浓度,有助于预防术后POCD的发生。
Objective To evaluate the effect of sevoflurane preconditioning on postoperative cognitive function in elderly patients with liver cancer undergoing hepatectomy. Methods Sixty patients with primary hepatocellular carcinoma undergoing elective partial hepatectomy were enrolled in this study. Their gender, age ranged from 65 to 75 years, weight ranged from 45 kg to 81 kg, ASA grade Ⅱ or Ⅲ. Patients were divided into two groups according to random number table Group (n = 30): control group (group C) and sevoflurane group (group S). Induction of anesthesia was induced by midazolam - sufentanil - etomidate anesthesia, mechanical ventilation was performed after intubation, and P_ (ET) CO_235 ~ 45 mmHg was maintained. Anesthesia Maintenance: Intravenous infusion of propofol, remifentanil, and intermittent intravenous injection of atracurbate mesylate. Intraoperative BIS value of 40 to 60. In group S, inhalation of end-expiratory volume at the end of expiration was equivalent to 2% sevoflurane for 20 min, followed by a 10-min elution period. In group C, only pure oxygen was administered, while others were the same as group S. The concentration of S-100β in serum was measured at T 1, T 1, T 2 and T 7 after T 1, T 2 and T 3, respectively The patient’s cognitive function test was performed on the Mini-Scale Intelligent Scale (MMSE) to record the occurrence of POCD. Results Compared with T 0, the serum S-100βprotein concentrations in both groups were significantly increased at T_1T_2 (P <0.05). Compared with C group, the serum S-100βprotein concentrations in S_ ), S-100β protein concentration in S group returned to T_0 when T_3, but was still higher than T_0 in C group. Compared with T_0, MMSE scores of both groups were significantly lower at T_2 (P <0.05). Compared with group C, MMSE score of group S was significantly increased (P <0.05) at T_2T_3, MMSE of group S was restored to T_0 at T_3, and still higher than group T_0 at time T_2. The incidences of POCD in group C and group S were 26.7% and 13.3%, respectively, and in group C were higher than those in group S (P <0.05). Conclusion Sevoflurane preconditioning can reduce the postoperative serum levels of S-100β in elderly patients with hepatocellular carcinoma after liver resection, which may be helpful to prevent postoperative POCD.