瑞芬太尼联合丙泊酚对直肠癌根治术患者围术期认知功能障碍的影响

Effects of Remifentanil Combined with Propofol on Perioperative Cognitive Dysfunction in Patients Undergoing Laparoscope-Assisted Radical Resection for Rectal Carcinoma

关键词:  瑞芬太尼  丙泊酚  术后认知障碍  直肠癌  β淀粉样蛋白  Tau蛋白

Key words:  remifentanil  propofol  postoperative cognitive dysfunction  rectal cancer  amyloid β-protein  Tau

摘要:

目的 探讨瑞芬太尼联合丙泊酚对直肠癌根治术患者围术期认知功能障碍的影响。方法 选择2015年1月-2018年1月100例行腹腔镜下直肠癌根治术的患者作为研究对象，依据随机数字表法将患者随机分为观察组和对照组，每组50例。对照组行异氟醚吸入和丙泊酚静脉麻醉，观察组患者采用瑞芬太尼联合丙泊酚。分析比较2组患者拔管时间、苏醒时间、苏醒期躁动发生例数；记录2组患者切皮时（T1）、手术开始60 min （T2）、手术结束时（T3）的心率（heart rate，HR）、平均动脉压（mean arterial pressure，MAP）；采用简易智能状态检查量表（mini-mental state examination，MMSE）对患者术前及术后3，7 d的神经精神功能进行评估，并比较2组患者的β-42淀粉样蛋白（Aβ-42）、Tau蛋白和pTau蛋白变化，记录相同时间点患者认知功能障碍（postoperative cognitive dysfunction，POCD）的发生率。结果 观察组患者苏醒用时、拔管用时、苏醒期躁动发生率明显低于对照组（P<0.05）。对照组切皮时、手术开始60 min、手术结束时的HR差异均无统计学意义；观察组在手术开始60 min、手术结束时的HR比切皮时明显降低（P<0.05），且明显低于对照组（P<0.05）。观察组患者术后3，7 d MMSE评分明显高于对照组（P<0.05），观察组POCD发生率明显低于对照组（P<0.05）。与麻醉前相比，2组术后3，7 d内Tau蛋白、pTau水平、Tau蛋白/Aβ-42值较麻醉前明显升高（P<0.05）、Aβ-42蛋白降低（P<0.05）；观察组患者术后3，7 d内Aβ-42水平高于对照组，Tau、pTau水平和Tau/Aβ-42低于对照组（P<0.05）。结论 瑞芬太尼联合丙泊酚静脉麻醉在腹腔镜下直肠癌根治术中镇痛效果显著，同时有效避免患者术后血清Tau蛋白、pTau蛋白水平过度升高、Aβ-42水平过度下降，改善患者的认知功能，降低患者术后认知功能障碍的发生率。

Abstract:

OBJECTIVE To explore the effects of remifentanil combined with propofol on perioperative cognitive dysfunction in patients undergoing laparoscope-assisted radical resection for rectal carcinoma. METHODS One hundred cases of rectal carcinoma patients undergoing laparoscope-assisted radical resection from January 2015 to January 2018 were selected as the objects. All of them were randomly divided into observation group and control group. The control group were received isoflurane and propofol. The observation group were given remifentanil combined with propofol intravenous anesthesia. The duration of anesthesia, recovery time, extubation time, intraoperative drug use and the number of cases of restlessness were compared between the two groups. The heart rate (HR) and mean arterial pressure (MAP) were recorded in two groups of patients with incision surgery (T1), operation start 60 min (T2), and at the end of the operation (T3). The neurological and psychiatric functions of preoperative and postoperative 3, 7 d patients were evaluated according to MMSE scale. The changes of amyloid β-protein(1-42) (Aβ-42), Tau protein and phosphorylated-Tau were compared between two groups, and the incidence of postoperative cognitive dysfunction (POCD) in two groups were recorded. RESULTS The recovery time, extubation time and the number of cases of restlessness in the observation group were significantly lower than those in control group(P<0.05). No difference was found on HR between the points of patients with incision surgery, operation start 60 min, and at the end of the operation in the control group. Compared with the point of patients with incision surgery, the HR had significantly decreased in T2, T3 in the observation group, the difference was statistically significant (P<0.05); compared with the control group, the HR of observation group were significantly lower than that in operation start 60 min, and at the end of the operation (P<0.05). The MMSE score in the observation group at 3, 7 d after operation were significantly higher than those in the control group, the difference was statistically significant(P<0.05), and the incidence of POCD in the observation group was significantly lower than that in the control group(P<0.05). Compared with preoperative anesthesia, the level of Tau protein and phosphorylated-Tau at 3, 7 d after operation were higher than before anesthesia, while the level of Aβ-42 protein had decreased and the Tau protein/Aβ-42 value increased (P<0.05), the Aβ-42 level in the observation group was higher than that in the control group, and the levels of Tau, phosphorylated-Tau and Tau/Ab-42 were lower than control group(P<0.05). CONCLUSION The implementation of remifentanil combined with propofol in the anesthesia of laparoscope-assisted radical resection for rectal carcinoma is effective. It can avoid the excessive increase of Tau protein and phosphorylated-Tau level and the excessive decrease of Aβ-42 level, improve cognitive function, and reduce the incidence of postoperative cognitive dysfunction.