亚剂量氯胺酮联合全凭静脉麻醉对行腹腔镜胆囊切除术老年患者认知功能和血清细胞因子水平的影响*

doi:10.3969/j.issn.1672-5069.2018.05.030

实用肝脏病杂志 ›› 2018, Vol. 21 ›› Issue (5): 773-776.doi: 10.3969/j.issn.1672-5069.2018.05.030

亚剂量氯胺酮联合全凭静脉麻醉对行腹腔镜胆囊切除术老年患者认知功能和血清细胞因子水平的影响^*

朱志华, 丛仔红, 刘爱霞, 李景明, 焦相学, 张元会

712000陕西省咸阳市第一人民医院麻醉科（朱志华,丛仔红,李景明,焦相学,张元会）; 陕西中医药大学第一附属医院内分泌一科（刘爱霞 )

收稿日期:2018-01-04 出版日期:2018-09-10 发布日期:2018-09-27
通讯作者: 张元会,E-mail:3249721546@qq.com
作者简介:朱志华，女，35岁，大学本科，主治医师。主要从事临床麻醉学研究。E-mail:3249721546@qq.com
基金资助:
咸阳市科技局科研基金资助项目（编号：2016K02-82）

Effects of sub-dose ketamine combined with total intravenous anesthesia on cognitive function and serum pro-inflammatory cytokine levels in elderly patients undergoing laparoscopic cholecystectomy

Zhu Zhihua, Cong Zaihong, Liu Aixia, et al.

Department of Anesthesiology,First People's Hospital,Xianyang 712000,Shaanxi Province,China

Received:2018-01-04 Online:2018-09-10 Published:2018-09-27

摘要/Abstract

摘要： 目的探讨亚剂量氯胺酮联合全凭静脉麻醉对行腹腔镜胆囊切除术（LC）的老年胆囊结石患者术后认知功能和血清细胞因子的影响。方法 2015年6月~2016年6月我院治疗的75例行LC手术的胆囊结石老年患者,被随机分为观察组40例,接受亚剂量的氯胺酮联合全凭静脉麻醉,和对照组35例,只接受全凭静脉麻醉。采用Ramsay评分评价镇静效果,采用简易智力状态量表（MMSE）评分评估认知功能,采用ELISA法检测血清肿瘤坏死因子（TNF-α）、白细胞介素-1β（IL-1β）和白细胞介素-6（IL-6）水平。结果在麻醉停止时、停止后10 min、停止后30 min和停止后1 h,观察组Ramsay评分分别为（4.3±0.3）分、（3.1±0.5）分、（2.5±0.3）分和（2.3±0.3）分,均显著低于对照组的[（4.5±0.4）分、（3.4±0.5）分、（3.1±0.4）分和（2.7±0.5）分,P<0.05];在拔管后1 h、拔管后3 h、术后1 d和3 d,观察组MMSE评分分别为（17.5±0.7）分、（20.6±0.7）分、（26.1±1.3）分和（27.3±0.9）分,均显著高于对照组的[（14.6±0.7）分、（15.7±0.8）分、（20.3±1.4）分和（25.1±1.1）分,P<0.05];在切除胆囊时和拔管 30 min 后,观察组血清TNF-α、IL-1β和IL-6水平均显著高于对照组（P<0.05）;观察组术后苏醒时间为（13.5±1.8）min、拔管时间为（18.2±1.7） min,定向力恢复时间为（20.4±1.8） min,均显著早于对照组的[（15.7±1.5） min、（20.6±2.1） min和（23.8±2.9） min,P<0.05]。结论采用亚剂量的氯胺酮联合全凭静脉麻醉能够有效提高行LC手术老年患者的麻醉效果,不影响认知功能,抑制患者体内炎症反应,且用药安全,具有临床应用价值。

关键词: 胆囊结石, 亚剂量氯胺酮, 全凭静脉麻醉, 认知功能, 细胞因子, 老年

Abstract: Objective To investigate the effects of sub-dose ketamine combined with total intravenous anesthesia on cognitive function and serum pro-inflammatory cytokine levels in elderly patients undergoing laparoscopic cholecystectomy（LC）. Methods 75 elderly with cholecystolithiasis were recruited in our hospital between June 2015 and June 2016,and all of them underwent LC. During the operation,the patients were randomly divided into observation group（n=40） receiving ketamine and intravenous anesthesia,and control group receiving intravenous anesthesia alone. The satisfaction of anesthesia was assessed by Ramsay’s score,and the cognition was assessed by mini mental state scale （MMSE） score. Serum tumor necrosis factor alpha （TNF-alpha）,interleukin-1 beta（IL-1 beta） and interleukin-6（IL-6） were detected by ELISA. Results At the end of anesthesia,10 min,30 min and 1 hour after the discontinuation of anesthesia,the Ramsay’s scores in the observation group were （4.3±0.3）,（3.1±0.5）,（2.5±0.3） and （2.3±0.3）,much lower than[（4.5±0.4）,（3.4±0.5）,（3.1±0.4） and （2.7±0.5）,P<0.05] in the control;1 h, 3 h,1 d and 3 d after extubation, the MMSE scores were （17.5±0.7）,（20.6±0.7）,（26.1±1.3） and（27.3±0.9）,much higher than [（14.6±0.7）（15.7±0.8）,（20.3±1.4） and（25.1±1.1）,P<0.05] in the control;at the end of the operation and 30 min after extubation,serum TNF-α,IL-1β and IL-6 levels were significantly higher than those in the control（P<0.05）;the awakening time,the time of extubation and orientation recovery were （13.5±1.8） min,（18.2±1.7） min and （20.4±1.8）min,much earlier than[（15.7±1.5） min,（20.6±2.1） min and（23.8±2.9）min,respectively,P<0.05] in the control. Conclusion The combination of total intravenous anesthesia and subdose ketamine can effectively improve the cognitive function in elderly patients undergoing LC operation. It has good anesthetic effect, and the mechanism might be related to the suppression of inflammatory reactions.

Key words: Cholecystolithiasis, Subdose ketamine, Total intravenous anesthesia, Cognitive function, Proinflammatory cytokines, Elderly

朱志华, 丛仔红, 刘爱霞, 李景明, 焦相学, 张元会. 亚剂量氯胺酮联合全凭静脉麻醉对行腹腔镜胆囊切除术老年患者认知功能和血清细胞因子水平的影响^*[J]. 实用肝脏病杂志, 2018, 21(5): 773-776.

Zhu Zhihua, Cong Zaihong, Liu Aixia, et al.. Effects of sub-dose ketamine combined with total intravenous anesthesia on cognitive function and serum pro-inflammatory cytokine levels in elderly patients undergoing laparoscopic cholecystectomy[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2018, 21(5): 773-776.

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亚剂量氯胺酮联合全凭静脉麻醉对行腹腔镜胆囊切除术老年患者认知功能和血清细胞因子水平的影响^*

Effects of sub-dose ketamine combined with total intravenous anesthesia on cognitive function and serum pro-inflammatory cytokine levels in elderly patients undergoing laparoscopic cholecystectomy

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