远隔缺血预处理对老年患者肝癌手术 术后早期认知功能的影响

Effect of remote ischemic preconditioning on postoperative cognition in elderly patients undergoing liver cancer surgery

摘要:

目的 探讨远隔缺血预处理对老年患者肝癌手术术后早期认知功能的影响。方法 选取老年肝癌 患者60 例，ASA Ⅱ、Ⅲ级，随机分为对照组（C 组）和远隔缺血预处理（RIPC）组（R 组），每组30 例。两 组患者均采用相同的麻醉方法，R 组在麻醉诱导后手术开始前进行肢体RIPC 处理。分别于手术前、手术结 束后测定两组患者血清8- 异- 前列腺素F2α（8-iso-PGF2α）、白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α） 及S100β 蛋白的浓度，计算颈内动- 静脉血氧含量差（Da-jvO2）、颈内静脉球部血氧含量（CjvO2）及脑氧摄 取率（CERO2），并统计术后7 d 内术后认知功能障碍（POCD）发生率。结果 两组患者手术结束后与术前血 清8-iso-PGF2α、IL-6、TNF-α、S100β 蛋白与Da-jvO2、CERO2 比较，差异有统计学意义（P <0.05），手术结 束后各指标高于术前；手术结束后R 组与C 组各指标比较，差异有统计学意（P <0.05），R 组各指标低于C 组； 术后7 d 内POCD 发生率比较，差异有统计学意义（P <0.05），R 组低于C 组。结论 远隔缺血预处理能降低肝 癌手术老年患者术后早期认知功能障碍的发生率，其机制可能与减轻氧化应激反应，抑制炎症反应，改善脑氧 代谢有关。

Abstract:

Objective To investigate the effect of remote ischemic preconditioning (RIPC) on early postoperative cognitive function in elderly patients undergoing liver cancer surgery. Methods Sixty ASA II and III elderly patients scheduled for liver cancer resection were randomly divided into 2 groups (30 in each group): a control group (group C) and a RIPC group (group R). The same anesthesia was applied in the two groups. After anesthesia induction the group R received limb RICP. The serum levels of 8-iso-PGF2α, IL-6, TNF-α and S100β protein were measured and Da-jvO2, CjvO2 and CERO2 were calculated before operation and at the end of operation respectively. The incidences of postoperative cognitive dysfunction (POCD) were recorded within 7 days after operation. Results In both groups, the serum levels of 8-iso-PGF2α, IL-6, TNF-α, S100β protein, Da-jvO2 and CERO2 significantly increased at the end of operation compared with those before operation (P < 0.05). At the end of operation, the serum levels of 8-iso-PGF2α, IL-6, TNF-α, S100β protein, Da-jvO2 and CERO2 in the group R were significantly lower than those in the group C (P < 0.05). The incidence of POCD in the group R was lower than that of the group C within 7 days after operation (P < 0.05). Conclusions RIPC can decrease the incidence of early POCD in the elderly patients undergoing liver cancer resection, the mechanism may be reduction of oxidative stress response, inhibition of inflammatory response to the patients and improvement of the cerebral oxygen metabolism during operation.