Yao Jingping, Gao Zhuoyue, Qu Wa, Li Jingjing
Department of Anesthesiology, Daqing Oil Field General Hospital, Daqing, Heilongjiang 163000, P.R. China.
Department of Anesthesia, Southern University of Science and Technology Hospital, Shenzhen, Guangdong 518000, P.R. China.
Exp Ther Med. 2024 Jul 1;28(3):343. doi: 10.3892/etm.2024.12632. eCollection 2024 Sep.
Propofol total intravenous anesthesia (TIVA) or sevoflurane inhalation anesthesia (IA) affects post-operative cognitive dysfunction in geriatric patients undergoing laparoscopic surgery; however, relevant real-world clinical evidence on the matter is limited. The present study aimed to compare the effects of propofol TIVA and sevoflurane IA on post-operative cognitive dysfunction in the aforementioned type of patients. The present prospective study enrolled 197 geriatric patients undergoing laparoscopic surgery. Patients were assigned to the propofol TIVA group (n=97) and sevoflurane IA group (n=100) according to the actual anesthesia regimens. The mini-mental state examination (MMSE) score was assessed before surgery and on day (D)1, D3 and D7 following surgery in both groups. The MMSE score on D1 was higher in the TIVA group compared with the IA group (P=0.006). The change in the MMSE scores from before surgery to D1 (P<0.001), D3 (P=0.011) and D7 (P=0.003) was smaller in the TIVA group vs. the IA group. Multivariate linear regression analyses suggested that the anesthesia method of TIVA (vs. IA) was independently related to the increased MMSE score on D1 (b=0.803; P=0.001) and D7 (b=0.472; P=0.025). The levels of interleukin (IL)-17A, IL-6 and tumor necrosis factor-α on D1, D3 and D7 exhibited a slightly decreasing trend in the TIVA group vs. the IA group, although the difference was not statistically significant (all P>0.05). Notably, the levels of IL-17A before surgery (P=0.015), on D3 (P=0.016) and D7 (P=0.002), as well as those of IL-6 on D1 (P=0.027), were negatively associated with the MMSE score at the corresponding time points. Overall, the present study demonstrates that propofol TIVA ameliorates post-operative cognitive dysfunction on D1 compared with sevoflurane IA and exerts a potentially suppressive effect on inflammation in geriatric patients undergoing laparoscopic surgery.
丙泊酚全静脉麻醉（TIVA）或七氟醚吸入麻醉（IA）对接受腹腔镜手术的老年患者术后认知功能障碍有影响；然而，关于此事的相关真实世界临床证据有限。本研究旨在比较丙泊酚TIVA和七氟醚IA对上述类型患者术后认知功能障碍的影响。本前瞻性研究纳入了197例接受腹腔镜手术的老年患者。根据实际麻醉方案，将患者分为丙泊酚TIVA组（n = 97）和七氟醚IA组（n = 100）。在两组患者手术前以及术后第1天（D1）、第3天（D3）和第7天评估简易精神状态检查表（MMSE）评分。与IA组相比，TIVA组D1时的MMSE评分更高（P = 0.006）。与IA组相比，TIVA组从手术前到D1（P < 0.001）、D3（P = 0.011）和D7（P = 0.003）时MMSE评分的变化更小。多因素线性回归分析表明，TIVA（与IA相比）的麻醉方法与D1（b = 0.803；P = 0.001）和D7（b = 0.472；P = 0.025）时MMSE评分的升高独立相关。与IA组相比，TIVA组D1、D3和D7时白细胞介素（IL）-17A、IL-6和肿瘤坏死因子-α水平呈略有下降趋势，尽管差异无统计学意义（所有P > 0.05）。值得注意的是，手术前（P = 0.015）、D3（P = 0.016）和D7（P = 0.002）时的IL-17A水平以及D1时的IL-6水平（P = 0.027）与相应时间点的MMSE评分呈负相关。总体而言，本研究表明，与七氟醚IA相比，丙泊酚TIVA可改善老年腹腔镜手术患者术后第1天的认知功能障碍，并对炎症具有潜在的抑制作用。
