格隆溴铵对老年患者腹腔镜腹股沟疝修补术的术后认知功能障碍的影响

Effect of glycopyrronium bromide on postoperative cognitive dysfunction in elderly patients undergoing laparoscopic inguinal hernia repair surgery

摘要:

目的 探讨格隆溴铵术前用药对老年患者腹腔镜腹股沟疝修补术的术后认知功能障碍（POCD）的影响。方法 选取择期行喉罩全身麻醉腹腔镜腹股沟疝修补手术的老年患者74例，随机分为对照组（C组，25例）、低剂量格隆溴铵组（0.2 mg，L组，24例）和中剂量格隆溴铵组（0.4 mg，M组，25例）。于术前1 d和手术后3 d分别采集患者血液样本，采用ELISA法检测血清炎症因子［白细胞介素-1β（IL-1β）、白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）］和脑功能相关因子［5-羟色胺（5-HT）和脑源性神经营养因子（BDNF）］含量，分析术前和术后血清5-HT、炎症因子和BDNF的变化。使用蒙特利尔认知评估量表（MoCA）对术前1 d和手术后3 d患者的认知功能进行评估，并分析手术前后患者认知功能的变化。记录置入喉罩前或拔除喉罩后气道分泌物评分、心律失常、口干和排尿困难的发生情况。结果 3组患者POCD发生率比较，差异无统计学意义（P > 0.05）；术后3 d，L组血清5-HT和BDNF水平明显高于C组，L组血清BDNF水平明显高于M组，差异均有统计学意义（P < 0.05）；术后3 d，C组血清IL-1β、IL-6和TNF-α水平较术前1 d明显升高，差异均有统计学意义（P < 0.05），M组血清IL-6和TNF-α水平较术前1 d明显升高，差异均有统计学意义（P < 0.05），L组血清IL-1β、IL-6和TNF-α水平与术前1 d比较，差异均无统计学意义（P > 0.05），3组患者术后3 d血清IL-1β、IL-6和TNF-α水平组间比较，差异均无统计学意义（P > 0.05）；与C组比较，L组和M组术后气道分泌物明显减少，差异均有统计学意义（P < 0.05），但L组与M组比较，差异无统计学意义（P > 0.05）；M组不良反应发生率（口干和排尿困难）较L组和C组明显增加，差异均有统计学意义（P < 0.05）。结论 低剂量（0.2 mg）格隆溴铵更适合作为老年患者腹腔镜腹股沟疝修补术的术前用药，增加剂量可能增加POCD和不良反应的风险。

Abstract:

Objective To explore the effect of preoperative administration of glycopyrronium bromide on postoperative cognitive dysfunction (POCD) in elderly patients undergoing laparoscopic inguinal hernia repair surgery.Methods 74 elderly patients underwent laparoscopic inguinal hernia repair surgery under general anesthesia with a laryngeal mask were randomly divided into control group (group C, 25 cases), low-dose glycopyrronium bromide group (0.2 mg, group L, 24 cases), medium-dose glycopyrronium bromide group (0.4 mg, group M, 25 cases). Blood was collected from patients 1 d before surgery and 3 d after surgery, and serum levels of interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), brain function related factors [5-hydroxytryptamine (5-HT), brain-derived neurotrophic factor (BDMF)] were measured by enzyme linked immunosorbent assay (ELISA). The Montreal Cognitive Assessment Scale (MoCA) was used to assess the cognitive function of the patients. Airway secretion scores, the incidence of arrhythmia, dry mouth and dysuria were recorded.Results There was no significant difference in the incidence of POCD among the three groups of patients (P > 0.05); At 3 d postoperatively, 5-HT and BDNF levels in group L were higher than those in group C, the BDNF level in group L was higher than that in group M, there were statistically significant (P < 0.05); At 3 days after surgery, the levels of serum IL-1β, IL-6 and TNF-α in group C were significantly higher than those at 1 day before surgery (P < 0.05), the levels of serum IL-6 and TNF-α in group M were significantly higher than those at 1 day before surgery (P < 0.05), there were no significant differences in the levels of serum IL-1β, IL-6 and TNF-α in group L compared with those at 1 day before surgery (P > 0.05), there were no significant differences in the levels of serum IL-1β, IL-6 and TNF-α among the three groups at 3 days after surgery (P > 0.05); Postoperative airway secretion was significantly reduced in group L and group M compared with group C (P < 0.05), and there was no significant difference between group L and group M (P > 0.05). The incidence of adverse reactions (dry mouth and dysuria) in group M was significantly higher than that in group L and group C (P < 0.05).Conclusion Low-dose (0.2 mg) glycopyrronium bromide is more appropriately recommended as a preoperative medication for elderly patients undergoing laparoscopic inguinal hernia repair surgery, and increased dosage is associated with an increase in adverse reactions and POCD.