七氟醚联合右美托咪定对老年食管癌根治术患者应激反应、细胞免疫功能和认知功能的影响

摘要 目的：探讨右美托咪定、七氟醚复合麻醉在老年食管癌根治术患者中的应用价值，并观察患者细胞免疫功能、应激反应、认知功能的变化情况。方法：纳入我院2021年1月~2022年6月期间收治的老年食管癌根治术患者96例，采用随机数字表法分组，分别为A组（32例，七氟醚）、B组（32例，七氟醚复合丙泊酚）、C组（32例，七氟醚复合右美托咪定）。观察三组血流动力学指标、应激反应指标、细胞免疫功能和认知功能的变化，并记录三组不良反应发生情况。结果：B组、C组气管插管即刻（T1）~术毕（T3）时间点心率（HR）、平均动脉压（MAP）低于A组，且C组低于B组（P<0.05）。B组、C组术后3 d肾上腺素（E）、去甲肾上腺素（NE）和多巴胺（DA）低于A组，且C组低于B组（P<0.05）。B组、C组术后3 d CD4+、CD3+、CD4+/CD8+高于A组，且C组高于B组（P<0.05）。B组、C组术后3 d CD8+低于A组，且C组低于B组（P<0.05）。B组、C组术后3 d蒙特利尔认知评估（MoCA）评分、简明精神状态量表（MMSE）评分高于A组，且C组高于B组（P<0.05）。C组的术后认知功能障碍（POCD）发生率低于A组和B组（P<0.05）。A组和B组的POCD发生率组间对比无统计学差异（P>0.05）。三组不良反应发生率组间对比无统计学差异（P>0.05）。结论：老年食管癌根治术患者应用七氟醚联合右美托咪定复合麻醉，可维持血流动力学稳定，改善机体应激反应、免疫抑制和认知功能损害，且效果较好。

Effects of Sevoflurane Combined with Dexmedetomidine on Stress Response, Cellular Immune Function and Cognitive Function in Elderly Patients Undergoing Radical Resection of Esophageal Cancer

ABSTRACT Objective: To investigate the value of dexmedetomidine and sevoflurane combined anesthesia in elderly patients undergoing radical resection of esophageal cancer, and to observe the changes of cellular immune function, stress response and cognitive function. Methods: 96 elderly patients with esophageal cancer who were treated in our hospital from January 2021 to June 2022 were included. The patients were divided into group A (32 cases, sevoflurane), group B (32 cases, sevoflurane combined with propofol) and group C (32 cases, sevoflurane combined with dexmedetomidine) by random number table method. The changes of hemodynamic indexes, stress response indexes, cellular immune function and cognitive function in the three groups were observed, and the occurrence of adverse reactions in the three groups was recorded. Results: The heart rate (HR) and mean arterial pressure (MAP) at immediate endotracheal intubation (T1)~operation completion (T3) time points in group B and group C were lower than those in group A, and the group C was lower than the group B (P<0.05). The epinephrine (E), norepinephrine (NE) and dopamine (DA) in group B and group C at 3 d after operation were lower than those in group A, and the group C was lower than the group B(P<0.05). The CD4+, CD3+ and CD4+/CD8+ in group B and group C at 3 d after operation were higher than those in group A, and the group C was higher than the group B (P<0.05). 3 d after operation, CD8+ in group B and group C was lower than that in group A, and the group C was lower than the group B (P<0.05). The Montreal Cognitive Assessment(MoCA) score and Mini-Mental State Examination (MMSE) score in group B and group C were higher than those in group A, and the group C was higher than the group B(P<0.05). The incidence of postoperative cognitive dysfunction (POCD) in group C was lower than that in group A and group B(P<0.05). There was no significant difference in the incidence of POCD between group A and group B (P>0.05). There was no significant difference in the incidence of adverse reactions among the three groups (P>0.05). Conclusion: Combined anesthesia with sevoflurane and dexmedetomidine in elderly patients with esophageal cancer undergoing radical surgery can maintain hemodynamic stability, improve stress response, immunosuppression and cognitive impairment, and the effect is good.