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| 地塞米松对胃肠肿瘤根治术老年患者术后早期认知功能的影响 |
| Effects of dexamethasone on early postoperative cognitive function in elderly patients undergoing radical operation for gastrointestinal cancer |
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| DOI： |
| 中文关键词: 地塞米松 术后认知功能障碍 炎性反应 胃肠手术 |
| 英文关键词: Dexamethasone Postoperative cognitive dysfunction Inflammatory response Gastrointestinal surgery |
| 基金项目:江西省教育厅科学技术研究项目(150258);南昌大学第二附属医院科技计划青年基金(2016YNQN12008) |
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| 中文摘要: |
| 目的：观察术前应用地塞米松对老年胃肠肿瘤根治术患者术后早期认知功能的影响。方法选择本院2013年6月至2015年6月于全身麻醉下行胃肠肿瘤根治术的老年患者120例,男94例,女26例,年龄66~85岁,体重48~78 kg,ASA Ⅰ~Ⅲ级。采用随机数字表法,将患者随机均分为两组：地塞米松组(D 组)和生理盐水对照组(C 组)。D 组于术前1 h 静脉注射地塞米松10 mg (稀释成2 ml),C 组静脉注射等容量生理盐水2 ml。分别于术前1 d、术后1、3、7 d 时行简易智能量表(MMSE)评分,术后评分低于术前1分以上确定有认知功能下降,则诊断为发生术后认知功能障碍(POCD)。并分别于上述时点采集患者血样测定血清神经元特异性烯醇化酶(NSE)、星形胶质源性蛋白(S100β)、IL-1β、TNF-α、C 反应蛋白(CRP)及皮质醇(Cor)浓度。结果 D 组患者 POCD 发生率为9例(15.0%),明显低于 C 组的19例(31.7%)(P <0.05)。与 C 组比较,D 组患者术后1、3 d时血清 NSE、S100β、IL-1β、TNF-α、CRP 及 Cor 浓度明显降低(P <0.05)。结论术前应用地塞米松可改善老年胃肠肿瘤根治术患者的 POCD,其机制可能与其抑制炎性反应及 Cor 过度产生有关。 |
| 英文摘要: |
| Objective To investigate the effects of dexamethasone on early postoperative cogni-tive function in elderly patients undergoing radical operation for gastrointestinal cancer.Methods One hundred and twenty ASA Ⅰ-Ⅲ elderly patients aged 66-85 years,undergoing radical operation for gastrointestinal cancer were randomly divided into 2 groups (n = 60 each):dexamethasone group (group D)and control group (group C).Patients received 10 mg dexamethasone (2 ml)intravenously over 1 h before operation in group D.Group C received the equal volume of normal saline.The patients cognitive score was tested with mini-mental state examination (MMSE)at the time of 1l d preopera-tive,1 d,3 d and 7 d postoperative,as well as blood serum levels of neuron specific enolasel (NSE), S100β,IL-1β,TNF-α,C-reactive protein (CRP)and cortisol.Results The morbidity of POCD in group D was 9 (1 5.0%),it was significantly lower than 1 9 (31.7)% in group C (P <0.05).Com-pared with group C,serum levels of NSE,S100β,IL-1β,TNF-α,CRP and cortisol at 1 d and 3 d postoperative was significantly lower than that of group C (P <0.05 ),and there was no significant change 7 d postoperative in both groups.Conclusion Pretreatment with dexamethasone can improve early postoperative cognitive function in elderly patients undergoing radical operation for gastrointesti-nal cancer,and the mechanism may be associated with the inhibition of inflammatory response. |
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