不同剂量舒芬太尼对食管癌根治术术后谵妄发生率的影响

摘要

目的 探讨四种不同剂量舒芬太尼对食管癌根治术术后谵妄发生率的影响.方法 前瞻性选取2014年1月至2016年1月期间接受食管癌根治术的80例患者作为研究对象,所有患者均于手术期间使用舒芬太尼.按照麻醉剂量的不同分为A组(n=20)、B组(n=20)、C组(n=20)、D组(n=20),其中A组静脉注射生理盐水15ml,B、C、D组的麻醉药物使用剂量分别为0.1μg/kg、0.15μg/kg、0.2μg/kg.分别对四组患者麻醉前、术后1h、术后1d不同时间点的的谵妄发生率,应激反应以及炎症反应进行观察比较.结果 术后1h,四组患者的谵妄发生率虽然低于麻醉前,但差异无统计学意义(P＞0.05),而在术后1d后,四组患者的发生率呈现明显下降趋势,其中以C组的发生率最低,差异有统计学意义(P＜0.05);四组麻醉前的超氧化物歧化酶(SOD)活性、丙二醛(MDA)评分差异无统计学意义(P＞0.05),C组术后1h和术后1d的MDA和SOD评分明显低于其他三组(P＜0.05),其中A组评分最高;C组术后1h和术后1d的肿瘤坏死因子(TNF-α)和白介素6(IL-6)明显低于其他三组(P＜0.05),但与其麻醉前的评分比较,差异无统计学意义(P＞0.05),而其他三组术1h和术后1d的TNF-α和IL-6与麻醉前比较,差异有统计学意义(P＜0.05);与麻醉前相比,四组患者术后1 h和术后1 d的β淀粉样蛋白(Sl00β和Aβ)明显升高(P＜0.05),其中,C和 D组患者的升高水平明显低于其他两组.结论不同剂量舒芬太尼均可以在一定程度上减少食管癌根治术术后谵妄的发生,其中尤以中等剂量的效果最为明显,其可以更好抑制患者麻醉后应激反应.但其对患者的免疫功能亦有一定的抑制作用,具有一定的剂量依赖性.%Objective To investigate the effect of four different doses of sufentanil on postoperative delirium in patients undergoing radical resection of esophageal carcinoma. Methods From January 2014to January 2016,80patients undeigoing radical resection of esophageal carcinoma were forward-looking selected as the research objects. All patients were treated with sufentanil during the operation. According to the different dose they were divided into A group (n=20),B group (n=20), C group (n=20), D group (n=20), the A group was injected with normal saline 15ml, B, C, D group of anesthesia drug dosage was 0.1 g/kg, 0.15g/kg 0.2g/kg, respectively. The incidence of delirium, stress response and inflammatory response before anesthesia, postoperative 1 h, 1 d were investegated. Results The incidence of postoperative delirium in four groups of patients with 1 h is lower than before anesthesia, but the difference was not significant (P＞0.05), and at 1 d after operation, the incidence decreased, especially in C group, the difference was significant (P＜0.05). Superoxide dismutase (SOD) activity, malondialdehyde(MDA) score of the four groups before anesthesia was not statistically significant (P＞0.05), MDA and SOD of C group after 1 h and 1 d were significantly lower than the other three groups (P＜0.05), the highest score was in the A group; tumor necrosis factor (TNF-α) and interleukin 6 (IL-6) of C group 1 h and 1 d after operation was significantly lower than that of the other three groups (P＜0.05). The score had no significant difference before anesthesia (P＞0.05), while the other three groups 1 h and 1 d after TNF-alpha and IL-6 compared with those before anesthesia was statistically significant (P＜0.05). Compared with before anesthesia, the levels of S100and A in the four groups were significantly higher than those in the other two groups after 1 h and 1 d after operation (P＜0.05),and the levels of C and D groups in the two groups were significantly lower than those in the other two groups. Conclusion Different doses of sufentanil can reduce the occurrence of esophageal cancer delirium after radical operation to some extent, and the medium dose effect is most obvious. It can better inhibit stress response in patients after anesthesia. But it also has certain inhibitory effect on the immune function of the patients, with a dose dependent manner.