麻醉诱导前不同剂量盐酸戊乙奎醚对老年腹腔镜胆囊切除术患者氧化应激和血清S100β、NSE、BDNF的影响

摘要 目的：探讨麻醉诱导前不同剂量盐酸戊乙奎醚对老年腹腔镜胆囊切除术（LC）患者氧化应激和血清S100β、神经元特异性烯醇化酶（NSE）、脑源性神经营养因子（BDNF）的影响。方法：根据随机数字表法将2019年1月~2022年12月期间在我院择期行LC的150例老年患者分为高剂量组（盐酸戊乙奎醚0.015 mg/kg）、中剂量组（盐酸戊乙奎醚0.01 mg/kg）和低剂量组（盐酸戊乙奎醚0.005 mg/kg），每组各50例。对比三组血流动力学指标[心率（HR）、平均动脉压（MAP）]、氧化应激指标[超氧化物歧化酶（SOD）、丙二醛（MDA）和总抗氧化能力（T-AOC）]和血清S100β、NSE、BDNF水平、术后认知功能障碍（POCD）发生率及不良反应发生率。结果：中剂量组喉罩置入后5 min（T1）~停止气腹10 min后（T4）HR、MAP低于低剂量组、高剂量组（P<0.05）。中剂量组术后1d MDA低于低剂量组、高剂量组，SOD、T-AOC高于低剂量组、高剂量组（P<0.05）。中剂量组术后1d S100β、NSE低于低剂量组、高剂量组，BDNF高于低剂量组、高剂量组（P<0.05）。三组不良反应发生率对比未见统计学差异（P>0.05）。中剂量组POCD发生率低于低剂量组、高剂量组（P<0.05）。结论：老年LC患者麻醉诱导前应用0.01 mg/kg盐酸戊乙奎醚，可有效维持血流动力学稳定，减轻氧化应激和脑损伤程度。

Effects of Different Doses of Penehyclidine Hydrochloride before Anesthesia Induction on Oxidative Stress, Serum S100β, NSE and BDNF in Elderly Patients Undergoing Laparoscopic Cholecystectomy

ABSTRACT Objective: To investigate the effects of different doses of penehyclidine hydrochloride before anesthesia induction on oxidative stress, serum S100β, neuron-specific enolase (NSE) and brain-derived neurotrophic factor (BDNF) in elderly patients undergoing laparoscopic cholecystectomy (LC). Methods: 150 elderly patients who underwent elective LC in our hospital from January 2019 to December 2022 were divided into high dose group (penehyclidine hydrochloride 0.015 mg/kg), middle dose group (penehyclidine hydrochloride 0.01mg/kg) and low dose group (penehyclidine hydrochloride 0.005 mg/kg) according to the random number table method,with 50 cases in each group.The hemodynamic indexes [heart rate (HR), mean arterial pressure (MAP)], oxidative stress indexes [superoxide dismutase (SOD), malondialdehyde (MDA) and total antioxidant capacity (T-AOC)], serum levels of S100β, NSE and BDNF, incidence of postoperative cognitive dysfunction (POCD) and incidence of adverse reactions were compared among three groups. Results: HR and MAP in middle dose group were lower than those in low dose group and high dose group from 5 min after laryngeal mask placement (T1) to 10 min after stopping pneumoperitoneum (T4) (P<0.05). The MDA in middle dose group was lower than that in low dose group and high dose group, and the SOD and T-AOC were higher than those in low dose group and high dose group (P<0.05). S100β and NSE in middle dose group were lower than those in low dose group and high dose group, and BDNF was higher than that in low dose group and high dose group (P<0.05). There was no significant difference in the incidence of adverse reactions among three groups (P>0.05). The incidence of POCD in middle dose group was lower than that in low dose group and high dose group (P<0.05). Conclusion: The application of 0.01 mg/kg penehyclidine hydrochloride before anesthesia induction in elderly LC patients, which can effectively maintain hemodynamic stability and reduce the degree of oxidative stress and brain injury.