Postoperative cognitive dysfunction after inhalational anesthesia in elderly patients undergoing major surgery: the influence of anesthetic technique, cerebral injury and systemic inflammation.
Postoperative cognitive dysfunction after inhalational anesthesia in elderly patients undergoing major surgery: the influence of anesthetic technique, cerebral injury and systemic inflammation.
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DOI：
10.1186/s12871-015-0130-9
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发表时间：
2015-10-23
影响因子：
2.2
通讯作者：
Zhao X
中科院分区：
文献类型：
--
作者：
Qiao Y;Feng H;Zhao T;Yan H;Zhang H;Zhao X
据报道，老年患者在七氟烷吸入麻醉后发生术后认知功能障碍（POCD）的风险较高。我们假设在吸入麻醉而非静脉麻醉下接受大手术的老年患者中 POCD 的发生率更高。我们还测量了血浆 S-100β 蛋白浓度作为中枢神经系统损伤的生物标志物，并测量血浆白细胞介素 (IL)-6 和肿瘤坏死因子 (TNF)-α 浓度来判断全身炎症对 POCD 的影响。将90名年龄65-75岁计划切除食管癌的患者随机分为三组（n = 30）之一，如下：接受七氟烷麻醉的组（S组）； A组在七氟烷麻醉前接受术前甲基泼尼松龙治疗（S + MP组）；对照组则维持静脉注射异丙酚（C 组）。采用简易精神状态检查（MMSE）和蒙特利尔认知评估（MoCA）来测量患者手术前一天以及术后第一天、第三天和第七天的认知功能。麻醉前10分钟以及术后第一天、第三天和第七天测量血浆TNF-α、IL-6和S-100β蛋白浓度。三组的人口统计学、临床特征或围手术期血流动力学状态没有显着差异。术后第1、3、7天S组MMSE、MoCA评分显着低于异丙酚对照组（C组）和S + MP组（P <0.05）。术后第1周，S组血浆TNF-α、IL-6、S-100β蛋白浓度较C组显着升高（P<0.05），而S + MP组血浆TNF-α、IL-6、S-100β蛋白浓度显着低于S组（P<0.05）。在七氟烷吸入麻醉下接受大手术的老年患者中 POCD 的发生率高于静脉丙泊酚维持的老年患者，而在接受甲泼尼龙治疗的老年患者中 POCD 的发生率较低。此外，我们发现接受七氟醚麻醉的患者血浆中 S-100β 蛋白、TNF-α 和 IL-6 浓度升高。 ChiCTR-IOR-15007007 (02-09-2015)。
Elderly patients are reportedly at higher risk of postoperative cognitive dysfunction (POCD) after inhalational anesthesia with sevoflurane. We hypothesized that the incidence of POCD would be higher in elderly patients undergoing major surgery under inhalational rather than intravenous anesthesia. We also measured plasma S-100β protein concentration as a biomarker of central nervous system injury, and plasma interleukin (IL)-6 and tumor necrosis factor (TNF)-α concentrations to judge the contribution of systemic inflammation to POCD. Ninety patients aged 65–75 years scheduled for resection of an esophageal carcinoma were randomly assigned to one of three groups (n = 30) as follows: a group receiving sevoflurane anesthesia (Group S); a group receiving preoperative methylprednisolone before sevoflurane anesthesia (Group S + MP); and a control group maintained with intravenous propofol (Group C). The mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) were used to measure patients’ cognitive function the day before surgery, and on the first, third and seventh postoperative days. The plasma concentrations of TNF-α, IL-6 and S-100β protein were measured 10 min before anesthesia, and on the first, third and seventh postoperative days. There were no significant differences in the demographic or clinical characteristics, or perioperative hemodynamic status, of the three groups. The MMSE and MoCA scores were significantly lower in Group S than in the propofol control (Group C) and Group S + MP on the first, third and seventh postoperative days (P <0.05). Throughout the first postoperative week the plasma concentrations of TNF-α, IL-6, and S-100β protein were significantly elevated in Group S compared with Group C (P <0.05), but were significantly lower in Group S + MP than Group S (P <0.05). The incidence of POCD was higher in elderly patients undergoing major surgery under inhalational anesthesia with sevoflurane than those maintained on intravenous propofol, and lower in elderly patients pro-treating with methylprednisolone. Furthermore, we found elevated plasma concentrations of S-100β protein, TNF-α and IL-6 in those receiving sevoflurane anesthesia. ChiCTR-IOR-15007007 (02-09-2015).