艾司氯胺酮复合丙泊酚麻醉对老年乳腺癌根治术患者应激水平认知功能及血清BDNF NSE水平的影响

doi:10.3969/j.issn.1006-6233.2024.06.033

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摘要 目的: 探究艾司氯胺酮复合丙泊酚麻醉对老年乳腺癌根治术患者应激水平、认知功能及血清BDNF、NSE水平的影响。方法: 选取2020年5月至2022年7月于本院进行乳腺癌根治术90例老年患者,根据随机数字表法将其进一步分为观察组(45例,艾司氯胺酮联合丙泊酚)和对照组(45例,丙泊酚麻醉)。比较两组患者应激水平、认知功能及血清BDNF、NSE水平。结果: 观察组T2、T3、T4时间点皮质醇、肾上腺素水平相较于T0时间点均明显升高(P<0.05);对照组T1、T2、T3、T4时间点皮质醇、肾上腺素水平相较于T0时间点均明显升高(P<0.05);观察组T1、T2、T3、T4时间点皮质醇、肾上腺素水平升高幅度相较于对照组均明显降低(P<0.05);两组术后24h、48h认知功能评分及BDNF水平下降,NSE水平上升,且观察组变化优于对照组(P<0.05);观察组苏醒、拔管及定向力恢复时间相较于对照组均明显缩短(P<0.05)。结论: 艾司氯胺酮复合丙泊酚麻醉老年乳腺癌根治术患者可减轻机体应激反应、加快认知功能恢复、改善术后苏醒质量。

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	彭昌盛
	周建军
	胡旭华
	金明

关键词 ：老年乳腺癌根治术, 丙泊酚, 艾司氯胺酮, 应激水平, 认知功能

Abstract：Objective: To investigate the effects of es-ketamine combined with propofol anesthesia on stress levels, cognitive function, and serum BDNF and NSE levels in elderly patients undergoing radical mastectomy for breast cancer.Methods: Ninety elderly patients who underwent radical mastectomy for breast cancer at our hospital from May 2020 to July 2022 were selected and further divided into the observation group (45 cases, es-ketamine combined with propofol) and the control group (45 cases, propofol anesthesia) according to a random number table method. The stress levels, cognitive function, and serum BDNF and NSE levels of the two groups were compared.Results: In the observation group, cortisol and adrenaline levels at T2, T3, and T4 time points were significantly higher compared to T0 time point (P<0.05). In the control group, cortisol and adrenaline levels at T1, T2, T3, and T4 time points were significantly higher compared to T0 time point (P<0.05). The increase in cortisol and adrenaline levels at T1, T2, T3, and T4 time points in the observation group was significantly lower than that in the control group (P<0.05). Both groups showed a decrease in cognitive function scores and BDNF levels and an increase in NSE levels at 24h and 48h postoperatively, with the observation group showing better changes than the control group (P<0.05). The awakening, extubation, and orientation recovery times in the observation group were significantly shorter than those in the control group (P<0.05).Conclusion: Es-ketamine combined with propofol anesthesia in elderly patients undergoing radical mastectomy for breast cancer can reduce the body's stress response, accelerate cognitive function recovery, and improve the quality of postoperative awakening.

Key words： Elderly radical mastectomy for breast cancer Propofol Es-ketamine Stress levels Cognitive function

基金资助:湖北省卫生健康委员会科研项目,(编号:WJ2019H256)

通讯作者: 金明

引用本文:

彭昌盛, 周建军, 胡旭华, 金明. 艾司氯胺酮复合丙泊酚麻醉对老年乳腺癌根治术患者应激水平认知功能及血清BDNF NSE水平的影响[J]. 河北医学, 2024, 30(6): 1049-1053.
PENG Changsheng, ZHOU Jianjun, HU Xuhua, et al. Effects of Es-ketamine Combined with Propofol Anesthesia on Stress Levels Cognitive Function, and Serum BDNF and NSE Levels in Elderly Patients Undergoing Radical Mastectomy for Breast Cancer. HeBei Med, 2024, 30(6): 1049-1053.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2024.06.033 或 http://www.hbyxzzs.cn/CN/Y2024/V30/I6/1049

[1] Siegel RL,Miller KD,Fuchs HE,et al.Cancer statistics,2021[J].CA Cancer Clin,2021,71(1):7-33.
[2] 杨坤渹,李扬,易勤美.超声引导下罗哌卡因用于胸壁神经阻滞Ⅰ联合锯齿-肋间平面阻滞在乳腺癌改良根治术后镇痛效果的研究[J].河北医学,2021,27(4):571-575.
[3] 李斌,姜义,于奇.静脉+吸入麻醉减轻乳腺癌改良根治术病人的免疫抑制及神经损伤[J].安徽医药,2022,26(4):723-728.
[4] Cao SJ,Zhang Y,Zhang YX,et al.Long-term survival in older patients given propofol or sevoflurane anaesthesia for major cancer surgery:follow-up of a multicentre randomised trial[J].Br Anaesth,2023,131(2):266-275.
[5] 李锋.瑞马唑仑与丙泊酚用于乳腺癌根治术患者全麻诱导与维持的临床研究比较[J].现代医学与健康研究,2022,6(3):64-67.
[6] Cserni G.Histological type and typing of breast carcinomas and the WHO classification changes over time[J].Pathologica,2020,112(1):25-41.
[7] Pinto TCC,Machado L,Bulgacov TM,et al.Is the montreal cognitive assessment (MoCA) screening superior to the mini-mental state examination (MMSE) in the detection of mild cognitive impairment (MCI) and alzheimer's disease (AD) in the elderly[J].Int Psychogeriatr,2019,31(4):491-504.
[8] Al-Hilli Z,Wilkerson A.Breast surgery:management of postoperative complications following operations for breast cancer[J].Surg Clin North Am,2021,101(5):845-863.
[9] 郭顺,曾晓琴,李波,等.环泊酚与丙泊酚用于腹腔镜胆囊切除术全麻诱导与维持的比较[J].临床麻醉学杂志,2023,39(6):601-604.
[10] Han Y,Li P,Miao M,et al.S-ketamine as an adjuvant in patient-controlled intravenous analgesia for preventing postpartum depression:a randomized controlled trial[J].BMC Anesthesiol,2022,22(1):49.
[11] Zhu M,Xu S,Ju X,et al.Effects of the different doses of esketamine on postoperative quality of recovery in patients undergoing modified radical mastectomy:a randomized,double-blind,controlled trial[J].Drug Des Devel Ther,2022,16(2):4291-4299.
[12] Tao W,Zhang X,Ding J,et al.The effect of propofol on hypoxia- and TNF-α-mediated BDNF/TrkB pathway dysregulation in primary rat hippocampal neurons[J].CNS Neurosci Ther,2022,28(5):761-774.