老年患者腹腔镜结直肠癌根治术中七氟烷-丙泊酚联合麻醉对氧化应激和术后认知功能的影响

Effect of sevoflurane combined with propofol general anesthesia on oxidative stress and postoperative cognitive function in elderly patients undergoing laparoscopic radical resection of colorectal cancer

摘要:

目的 探讨七氟烷-丙泊酚麻醉对老年患者腹腔镜结直肠癌（CRC）根治术氧化应激及术后认知功能的影响，为优化老年患者麻醉方案提供参考依据。方法 选取2023年2月－2025年2月在该院行腹腔镜CRC根治术的老年患者90例。采用随机数表法分为对照组与观察组，各45例。对照组给予丙泊酚麻醉；观察组给予丙泊酚静脉输注+七氟烷吸入麻醉。观察两组患者血流动力学情况、麻醉恢复情况、术后疼痛程度、免疫功能、氧化应激水平、术后认知功能和不良反应发生情况。结果 两组患者麻醉前（T₀）、麻醉15 min（T₁）、麻醉30 min（T₂）和术毕即刻（T₃）的心率（HR）和平均动脉压（MAP）存在时间、组间和交互效应差异（P < 0.05），且在同一时间点（T₁、T₂和T₃）观察组上述指标高于对照组。两组患者T₀、T₁、T₂和T₃时点经皮动脉血氧饱和度（SpO₂）水平无时间、组间和交互效应（P > 0.05）。两组患者脑电双频指数（BIS）值比较，差异无统计学意义（P > 0.05）。观察组麻醉复苏时间和拔管时间较对照组短，差异均有统计学意义（P < 0.05）。观察组术后2、6、12和24 h的视觉模拟评分法（VAS）评分低于对照组，差异均有统计学意义（P < 0.05）。术后24和72 h两组患者的CD3⁺、CD4⁺和CD4⁺/CD8⁺较术前明显下降，CD8⁺较术前明显上升，但观察组同一时间点CD3⁺、CD4⁺和CD4⁺/CD8⁺高于对照组，CD8⁺低于对照组，差异均有统计学意义（P < 0.05）。术后24 h两组患者的丙二醛（MDA）和皮质醇（Cor）水平较术前升高，超氧化物歧化酶（SOD）水平较术前降低，且两组上述指标比较，差异均有统计学意义（P < 0.05）。两组患者的简易精神状态检查量表（MMSE）评分和蒙特利尔认知功能评估量表（MoCA）评分均存在时间、组间和交互效应，且在同一时间点（术后24 h、术后7 d和术后30 d）观察组MMSE评分和MoCA评分明显高于对照组，差异均有统计学意义（P < 0.05）。结论 七氟烷-丙泊酚联合麻醉可稳定老年患者腹腔镜CRC根治术的术中血流动力学，降低围手术期氧化应激水平，改善术后早期认知功能，缓解术后疼痛，维持患者免疫功能，具有一定的临床应用价值。

Abstract:

Objective To explore the effects of combined anesthesia with sevoflurane and propofol on oxidative stress and postoperative cognitive function in elderly patients undergoing laparoscopic radical resection of colorectal cancer (CRC), so as to provide a reference for optimizing anesthesia regimens for elderly patients.Method 90 elderly patients were included, all of whom underwent laparoscopic radical resection of CRC from February 2023 to February 2025. The subjects were divided into a control group and an observation group using the random number table method, each group with 45 patients. The control group was given propofol anesthesia; the observation group received intravenous infusion of propofol and inhalation of sevoflurane. Observe the hemodynamics and anesthesia recovery, postoperative pain, immune function, oxidative stress, postoperative cognitive function, and adverse reactions of two groups of patients.Results There were differences in heart rate (HR) and mean arterial pressure (MAP) between the two groups before anesthesia (T₀), 15 minutes after anesthesia (T₁), 30 minutes after anesthesia (T₂), and immediately after surgery (T₃) in terms of time, between-group, and interaction effects (P < 0.05). At the same time point (T₁, T₂ and T₃), the above indicators in the observation group were higher than those in the control group. There were no differences in the levels of percutaneous arterial oxygen saturation (SpO₂) between groups T₀, T₁, T₂, and T₃ time points in terms of time, between-to-group, and interaction effects (P > 0.05). There was no statistically significant difference in the BIS values between the two groups. The observation group had a shorter awakening time and extubation time compared to the control group, the differences were statistically significant (P < 0.05). The observation group had lower visual analogue scale (VAS) scores than the control group at 2, 6, 12, and 24 hours after surgery, the differences were statistically significant (P < 0.05). Compared with preoperative, postoperative 24 and 72 hours, the CD3⁺, CD4⁺, and CD4⁺/CD8⁺ levels in both groups of patients significantly decreased, while CD8⁺ levels increased. However, at the same time point, the observation group had higher levels of CD3⁺, CD4⁺, and CD4⁺/CD8⁺ than the control group, and lower levels of CD8⁺ than the control group, the differences were statistically significant (P < 0.05). Compared with preoperative and postoperative levels, the levels of malondialdehyde (MDA) and cortisol (Cor) increased 24 hours after surgery in both groups, while the levels of superoxide dismutase (SOD) decreased, and the differences in these indicators between the two groups were statistically significant (P < 0.05). There were differences in mini-mental status examination (MMSE) scores and Montreal Cognitive Assessment Scale (MoCA) scores between the two groups of patients in terms of time, between-group and interaction effects. Moreover, at the same time points (postoperative 24 hours, 7 days and 30 days), the MMSE scores and MoCA scores of the observation group were significantly higher than those of the control group (P < 0.05).Conclusion Sevoflurane combined with propofol general anesthesia can stabilize intraoperative hemodynamics, reduce perioperative oxidative stress levels, improve early postoperative cognitive function, alleviate postoperative pain, and offer benefits in preserving the immune response among elderly patients undergoing laparoscopic radical resection of CRC. This regimen provides a safe and effective perioperative management strategy for elderly patients and has certain clinical application value.