文章摘要
甲基强的松龙对老年患者胸腔镜辅助肺叶切除术后认知功能的影响
Effect of methylprednisolone on cognitive dysfunction after thoracoscopic assisted pulmonary lobectomy in elderly patients
  
DOI：10.12089/jca.2018.07.014
中文关键词: 甲基强的松龙  老年患者；术后认知功能障碍；胸腔镜
英文关键词: Methylprednisolone  Elderly patients  Cognitive function  Thoracoscopy
基金项目:
作者单位E-mail
赵楠 050000,石家庄市,河北医科大学第三医院麻醉科  
王秀丽 050000,石家庄市,河北医科大学第三医院麻醉科 wangxl301@aliyun.com 
王亮 050000,石家庄市,河北医科大学第三医院麻醉科  
赵爽 050000,石家庄市,河北医科大学第三医院麻醉科  
段卫东 050000,石家庄市,河北医科大学第三医院麻醉科  
王立峰 050000,石家庄市,河北医科大学第三医院麻醉科  
郭鹏 050000,石家庄市,河北医科大学第三医院麻醉科  
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中文摘要:
      
目的 评价甲基强的松龙对行胸腔镜辅助肺叶切除术老年患者术后认知功能的影响。

方法 择期行胸腔镜辅助肺叶切除术的老年患者60例, 男31例, 女29例, 年龄65～75岁, BMI 18.5～23.9 kg/m2, ASA Ⅰ 或 Ⅱ 级。采用随机数字表法, 将患者分为甲基强的松龙组(M组)和对照组(C组), 每组30例。M组于单肺通气前静脉滴注甲基强的松龙2 mg/kg, C组于同时点静脉滴注等容量生理盐水。于术前1 d, 术后3 和7 d采用简易精神状态量表(MMSE)评估患者认知功能, 计算患者术后认知功能障碍（POCD）发生率。于术前1 d, 术后1、3 和7 d晨8: 00空腹抽取外周静脉血记录血清皮质醇浓度和空腹血糖浓度。记录术后7 d肺部感染或肺不张等肺部并发症情况。

结果 与术前1 d 比较, 两组术后3 d MMSE评分明显降低(P<0.05)。与C组比较, M组术后3 d MMSE评分明显升高(P<0.05), POCD发生率明显降低(P<0.05), 血清皮质醇浓度明显降低(P<0.05)。两组不同时点空腹血糖浓度差异无统计学意义, 术后7 d肺部并发症情况差异无统计学意义。

结论 在行胸腔镜肺叶切除术老年患者中甲基强的松龙降低了POCD的发生率, 短暂抑制术后皮质醇水平, 不增加患者术后高血糖和肺部并发症的风险。
英文摘要:
      
Objective To evaluate the effect of methylprednisolone on postoperative cognitive dysfunction after thoracoscopic assisted pulmonary lobectomy in elderly patients.

Methods Patients undergoing elective thoracoscopic lobectomy assisted lobectomy including 60 patients, 31 males and 29 females, aged 65-75 years, BMI 18.5-23.9 kg/m2, and ASA physical status Ⅰ or Ⅱ. The patients were divided into methylprednisolone group (group M) and control group (group C) with random number table method, 30 cases in each group. Group M was intravenously infused with methylprednisolone (2 mg/kg) before single-lung ventilation. At the same time, group C was intravenously infused with equal volume of normal saline. Cognitive function was assessed by Mini-Mental state examination (MMSE) 1 d before operation and 3 d, 7 d after operation and POCD incidence was calculated. The serum cortisol concentration was recorded on the 1st day before surgery, and on the 1st, 3rd, and 7th day after operation in the morning at 8 o′clock. Recorded fasting blood glucose concentrations 1 day before surgery and 1,3 and 7 days after surgery. Pulmonary complications such as pulmonary infection or atelectasis were recorded 7 days after surgery.

Results Compared with 1 day before surgery, the MMSE scores of the two groups decreased significantly after 3 days (P<0.05). Compared with group C, the MMSE scores of group M increased significantly after 3 days (P<0.05), the incidence of POCD decreased significantly (P<0.05), and the serum cortisol concentration decreased significantly (P<0.05). There was no significant difference in fasting blood glucose concentrations between the two groups at different time points. There was no statistically significant difference in lung complications 7 days after surgery.

Conclusion Methylprednisolone in elderly patients undergoing thoracoscopic lobectomy reduces the incidence of POCD and temporarily inhibits postoperative cortisol levels without increasing the risk of postoperative hyperglycemia and pulmonary complications.
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