亚剂量氯胺酮辅助全凭静脉麻醉对行腹腔镜胆囊术老年患者术后认知功能与炎症因子的影响

Effect of low-dose Ketamine on postoperative cognitive function and inflammatory factors in elderly patients undergoing laparoscopic cholecystectomy with intravenous anesthesia

摘要:

探讨亚剂量氯胺酮辅助全凭静脉麻醉对行腹腔镜胆囊术老年患者术后认知功能与炎症因子的影响。方法南通大学附属医院2015 年2～10 月收治的80 例腹腔镜胆囊手术老年患者依据随机数字表法分为两组：对照组采用全凭静脉麻醉；观察组采用亚剂量氯胺酮辅助全凭静脉麻醉。比较两组麻醉效果、患者认知功能及炎症因子水平变化。结果观察组患者停止麻醉药后10、30 和60 min时Ramsay 评分低于对照组（p <0.05）；观察组患者拔管1 和3 h，术后1、3和7 d 时的MMSE 评分均高于对照组，差异具有统计学意义（p <0.05）；两组患者切皮前、胆囊切除时和拔管30 min 时血清炎症因子水平较术前升高（p <0.05），且观察组各时间点炎症因子水平低于对照组（p <0.05）；观察组腹腔镜胆囊术老年患者术后3 d 谵妄和认知功能障碍发生率低于对照组（p <0.05）；观察组腔镜胆囊术老年患者麻醉后恢复情况（拔管时间、苏醒时间和定向力恢复时间）优于对照组（p <0.05）；观察组不良反应率低于对照组（p >0.05）。多元线性回归分析表明TNF-α、IFN-γ 和IL-6 与患者MMSE 评分存在线性回归关系（p <0.05）。结论亚剂量氯胺酮辅助全凭静脉麻醉能够有效降低腹腔镜胆囊术老年患者术后认知功能障碍，抑制炎症因子释放，维持患者血流动力学稳定，麻醉效果良好，提高了患者围手术期的安全性。

Abstract:

To investigate the influence of low-dose Ketamine assisted total intravenous anesthesia on postoperative cognitive function and inflammatory factors in elderly patients undergoing laparoscopic gallbladder surgery. Methods Eighty cases of elderly patients undergoing laparoscopic cholecystectomy from February 2015 to October 2015 were randomly divided into control group (total intravenous anesthesia) and observation group (lowdose Ketamine assisted total intravenous anesthesia). Anesthetic effect, cognitive function and levels of inflammatory cytokines were compared between the two groups. Results Ramsay sedation scores of the patients in the observation group were significantly lower than those in the control group at 10, 30 and 60 min after cessation of anesthetics (p < 0.05). The MMSE score of the patients in the observation group was significantly higher than that in the control group at 1 and 3 h after extubation, 1, 3 and 7 d after surgery (p < 0.05). The serum levels of inflammatory cytokines before skin incision and during cholecystectomy and at 30 min after extubation were all increased in the two groups, and the levels of inflammatory factors in the patients of the observation group were much lower than those of the control group at each time point (p < 0.05). The incidences of delirium and cognitive dysfunction of thepatients in the observed group were significantly lower than those in the control group 3 d after laparoscopic surgery (p < 0.05). The extubation time, the recovery time and the orientation recovery time in the observation group were significantly shorter than those in the control group (p < 0.05). The adverse response rates of the observation group and the control group (5% and 10 %) showed no significant difference (x2 = 0.72,p > 0.05). Multiple linear regression analysis showed that the MMSE score was in linear regression relationships with TNF-α, IFN-γand IL-6 in patients (p < 0.05). Conclusions Low-dose Ketamine assisted total intravenous anesthesia in elderly patients undergoing laparoscopic cholecystectomy can effectively reduce postoperative cognitive dysfunction, inhibit release of inflammatory cytokines, maintain patient hemodynamic stability, obtain good anesthetic effect, and improve perioperative safety of the patients.