脂质代谢在七氟烷与丙泊酚麻醉对老年结直肠癌患者认知功能中的作用

doi:10.3877/cma.j.issn.2095-2015.2026.02.014

目的

探讨七氟烷与丙泊酚对脂质代谢的作用，并分析脂质代谢相关指标与认知功能的关系。

方法

纳入2023年1月至2025年3月拟于启东市中医院行腹腔镜下结直肠癌根治术的老年患者共计80例。依照随机数字表法将患者分配至七氟烷组（S组）或丙泊酚组（P组），每组40例。麻醉诱导：S组患者吸入8%七氟烷（氧流量6~8 L/min，氧浓度40%），静脉注射罗库溴铵0.3 mg/kg、舒芬太尼0.3 μg/kg；P组患者静脉注射丙泊酚1.5~2.0 mg/kg、罗库溴铵0.6~1.0 mg/kg、舒芬太尼0.6~1.0 μg/kg。麻醉维持：S组患者吸入七氟烷0.8~1.3 MAC，静脉泵注瑞芬太尼0.05~2.0 μg/（kg·min），间断静注罗库溴铵0.3 mg/kg；P组患者静脉泵注丙泊酚4.0~12.0 mg/（kg·h），静脉泵注瑞芬太尼0.05~2.0 μg/（kg·min），间断静注罗库溴铵0.6 mg/kg。评估两组患者麻醉前1天（T0）、术后1天（T1）、术后3天（T3）、术后7天（T7）的MMSE评分。于上述各时点抽取静脉血测定脂质代谢相关指标，包括总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、载脂蛋白A1、脂蛋白（a）。记录麻醉诱导期间低血压、心动过缓发生情况、麻醉诱导时长、术后恶心呕吐（PONV）、苏醒时间。

结果

S组患者T1时点、T3时点MMSE评分、载脂蛋白A1明显低于P组患者，差异有统计学意义（P<0.05）。S组患者T1时点、T3时点脂蛋白（a）明显高于P组患者，差异有统计学意义（P<0.05）。Spearman相关性分析显示，T1时点、T3时点载脂蛋白A1与同时点MMSE评分呈显著正相关（ρ=0.797，P<0.001；ρ=0.590，P<0.001）。T1时点、T3时点脂蛋白（a）与同时点MMSE评分呈显著负相关（ρ=－0.734，P<0.001；ρ=－0.388，P=0.001）。S组患者麻醉诱导期间低血压发生率明显低于P组患者，差异有统计学意义（P<0.05）。S组患者麻醉诱导时长明显高于P组患者，差异有统计学意义（P<0.05）。

结论

七氟烷可降低麻醉诱导期低血压的发生，但可能增加老年结直肠癌患者术后早期认知功能下降的风险。丙泊酚在认知保护和脂质代谢稳定方面表现更佳。脂质代谢相关指标，尤其是载脂蛋白A1与脂蛋白（a），与认知功能密切相关，提示脂质代谢可能在麻醉方式影响术后认知中的关键作用。

关键词: 结直肠癌, 七氟烷, 丙泊酚, 脂质代谢, 认知功能, 随机对照试验

Objective

To investigate the effects of sevoflurane and propofol on lipid metabolism and to analyze the relationship between lipid metabolism-related indicators and cognitive function.

Methods

A total of 80 elderly patients scheduled for laparoscopic radical resection of colorectal cancer in Qidong Hospital of Traditional Chinese Medicine from January 2023 to March 2025 were enrolled. According to a random number table, patients were allocated to the sevoflurane group (S group) or the propofol group (P group), with 40 patients in each group. Anesthesia induction: Patients in the S group received inhalation of 8% sevoflurane (oxygen flow 6-8 L/min, oxygen concentration 40%), intravenous rocuronium 0.3 mg/kg, and sufentanil 0.3 μg/kg. Patients in the P group received intravenous propofol 1.5-2.0 mg/kg, rocuronium 0.6-1.0 mg/kg, and sufentanil 0.6-1.0 μg/kg. Anesthesia maintenance: Patients in the S group received inhaled sevoflurane at 0.8-1.3 MAC, continuous intravenous infusion of remifentanil 0.05-2.0 μg/(kg·min), and intermittent intravenous rocuronium 0.3 mg/kg. Patients in the P group received continuous intravenous infusion of propofol 4.0-12.0 mg/(kg·h) and remifentanil 0.05-2.0 μg/(kg·min), with intermittent intravenous rocuronium 0.6 mg/kg. MMSE scores were assessed at 1 day before anesthesia (T0), and on postoperative day 1 (T1), day 3 (T3), and day 7 (T7). Venous blood samples were collected at the same time points to measure lipid metabolism-related indicators, including total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), apolipoprotein A1, and lipoprotein (a). In addition, intra-induction hypotension, bradycardia, induction time, postoperative nausea and vomiting (PONV), and recovery time were recorded.

Results

At T1 and T3, MMSE scores, apolipoprotein A1 in the S group were significantly lower than those in the P group (P<0.05), while lipoprotein (a) levels were significantly higher (P<0.05). Spearman correlation analysis showed that apolipoprotein A1 was positively correlated with MMSE scores at T1 and T3 (ρ=0.797, P<0.001; ρ=0.590, P<0.001), whereas lipoprotein (a) was negatively correlated with MMSE scores at T1 and T3 (ρ=-0.734, P<0.001; ρ=-0.388, P=0.001). During anesthesia induction, the incidence of hypotension was significantly lower in the S group compared with the P group (P<0.05), while the induction time was significantly longer (P<0.05).

Conclusion

Sevoflurane can reduce the incidence of hypotension during anesthesia induction, but may increase the risk of early postoperative cognitive decline in elderly patients undergoing colorectal cancer surgery. Propofol shows advantages in cognitive protection and lipid metabolism stability. Lipid metabolism-related indicators, especially apolipoprotein A1 and lipoprotein (a), are closely associated with cognitive function, suggesting that lipid metabolism may play a key role in mediating the impact of anesthetic techniques on postoperative cognition.

Key words: Colorectal cancer, Sevoflurane, Propofol, Lipid metabolism, Cognitive function, Randomized controlled trial

表1 两组患者一般资料的比较（

±s）

组别	例数	年龄(岁,±s)	性别(男/女,例)	体重指数(kg/m²,±s)	美国麻醉医师协会分级(Ⅱ/Ⅲ,例)	高血压[例(%)]	糖尿病[例(%)]	手术时长(min,±s)
S组	40	73.7±5.0	23/17	22.9±3.2	19/21	14(35.0)	10(25.0)	177.2±23.5
P组	40	74.1±4.6	20/20	22.6±3.5	16/24	17(42.5)	12(30.0)	181.5±27.9
t/χ²值		0.372	0.453	0.400	0.457	0.474	0.251	0.746
P值		0.711	0.501	0.690	0.499	0.491	0.617	0.458

表1 两组患者一般资料的比较（

±s）

组别	例数	年龄(岁,±s)	性别(男/女,例)	体重指数(kg/m²,±s)	美国麻醉医师协会分级(Ⅱ/Ⅲ,例)	高血压[例(%)]	糖尿病[例(%)]	手术时长(min,±s)
S组	40	73.7±5.0	23/17	22.9±3.2	19/21	14(35.0)	10(25.0)	177.2±23.5
P组	40	74.1±4.6	20/20	22.6±3.5	16/24	17(42.5)	12(30.0)	181.5±27.9
t/χ²值		0.372	0.453	0.400	0.457	0.474	0.251	0.746
P值		0.711	0.501	0.690	0.499	0.491	0.617	0.458

表2 两组患者各时点MMSE评分、脂质代谢相关指标的比较（

±s）

指标	组别	例数	时点
指标	组别	例数	T0	T1	T3	T7
MMSE评分	S组	40	28.6±1.0	22.4±2.5	23.4±2.4	26.9±1.8
	P组	40	28.5±1.1	24.7±2.9	25.8±2.7	27.4±1.9
	t值		0.425	3.799	4.202	1.208
	P值		0.671	<0.001	<0.001	0.231
总胆固醇(mmol/L)	S组	40	4.7±0.5	4.8±0.9	4.8±0.6	4.7±0.7
	P组	40	4.8±0.6	4.6±0.6	4.7±0.8	4.6±0.7
	t值		0.810	1.169	0.633	0.639
	P值		0.421	0.246	0.529	0.525
甘油三酯(mmol/L)	S组	40	1.8±0.2	1.7±0.3	1.7±0.4	1.7±0.3
	P组	40	1.8±0.3	1.8±0.4	1.8±0.4	1.8±0.3
	t值		-	1.265	1.118	1.491
	P值		1.000	0.210	0.267	0.140
高密度脂蛋白胆固醇(mmol/L)	S组	40	1.1±0.2	1.0±0.1	1.1±0.2	1.1±0.2
	P组	40	1.1±0.2	1.1±0.2	1.1±0.3	1.2±0.3
	t值		0.671	1.131	0.702	1.052
	P值		0.504	0.261	0.485	0.296
载脂蛋白A1(g/L)	S组	40	1.5±0.2	1.1±0.3	1.2±0.3	1.4±0.4
	P组	40	1.5±0.3	1.3±0.4	1.4±0.3	1.5±0.4
	t值		0.526	2.530	2.981	1.118
	P值		0.600	0.013	0.004	0.267
脂蛋白(a)(mg/dL)	S组	40	35.2±6.9	38.7±7.2	38.2±6.3	36.5±7.0
	P组	40	34.9±7.2	35.6±6.6	35.3±6.0	34.8±6.4
	t值		0.190	2.007	2.108	1.134
	P值		0.850	0.048	0.038	0.260

表2 两组患者各时点MMSE评分、脂质代谢相关指标的比较（

±s）

指标	组别	例数	时点
指标	组别	例数	T0	T1	T3	T7
MMSE评分	S组	40	28.6±1.0	22.4±2.5	23.4±2.4	26.9±1.8
	P组	40	28.5±1.1	24.7±2.9	25.8±2.7	27.4±1.9
	t值		0.425	3.799	4.202	1.208
	P值		0.671	<0.001	<0.001	0.231
总胆固醇(mmol/L)	S组	40	4.7±0.5	4.8±0.9	4.8±0.6	4.7±0.7
	P组	40	4.8±0.6	4.6±0.6	4.7±0.8	4.6±0.7
	t值		0.810	1.169	0.633	0.639
	P值		0.421	0.246	0.529	0.525
甘油三酯(mmol/L)	S组	40	1.8±0.2	1.7±0.3	1.7±0.4	1.7±0.3
	P组	40	1.8±0.3	1.8±0.4	1.8±0.4	1.8±0.3
	t值		-	1.265	1.118	1.491
	P值		1.000	0.210	0.267	0.140
高密度脂蛋白胆固醇(mmol/L)	S组	40	1.1±0.2	1.0±0.1	1.1±0.2	1.1±0.2
	P组	40	1.1±0.2	1.1±0.2	1.1±0.3	1.2±0.3
	t值		0.671	1.131	0.702	1.052
	P值		0.504	0.261	0.485	0.296
载脂蛋白A1(g/L)	S组	40	1.5±0.2	1.1±0.3	1.2±0.3	1.4±0.4
	P组	40	1.5±0.3	1.3±0.4	1.4±0.3	1.5±0.4
	t值		0.526	2.530	2.981	1.118
	P值		0.600	0.013	0.004	0.267
脂蛋白(a)(mg/dL)	S组	40	35.2±6.9	38.7±7.2	38.2±6.3	36.5±7.0
	P组	40	34.9±7.2	35.6±6.6	35.3±6.0	34.8±6.4
	t值		0.190	2.007	2.108	1.134
	P值		0.850	0.048	0.038	0.260

表3 MMSE评分与脂质代谢相关指标的Spearman相关性分析结果

脂质代谢相关指标	时点	ρ	P值
总胆固醇	T0	-0.025	0.846
	T1	0.047	0.711
	T3	0.192	0.126
	T7	0.049	0.697
甘油三酯	T0	-0.034	0.786
	T1	0.157	0.211
	T3	-0.033	0.793
	T7	0.029	0.820
高密度脂蛋白胆固醇	T0	0.097	0.441
	T1	0.058	0.647
	T3	0.072	0.567
	T7	0.120	0.339
载脂蛋白A1	T0	0.063	0.620
	T1	0.797	<0.001
	T3	0.590	<0.001
	T7	0.133	0.292
脂蛋白(a)	T0	-0.123	0.328
	T1	-0.734	<0.001
	T3	-0.388	0.001
	T7	-0.177	0.158

表3 MMSE评分与脂质代谢相关指标的Spearman相关性分析结果

脂质代谢相关指标	时点	ρ	P值
总胆固醇	T0	-0.025	0.846
	T1	0.047	0.711
	T3	0.192	0.126
	T7	0.049	0.697
甘油三酯	T0	-0.034	0.786
	T1	0.157	0.211
	T3	-0.033	0.793
	T7	0.029	0.820
高密度脂蛋白胆固醇	T0	0.097	0.441
	T1	0.058	0.647
	T3	0.072	0.567
	T7	0.120	0.339
载脂蛋白A1	T0	0.063	0.620
	T1	0.797	<0.001
	T3	0.590	<0.001
	T7	0.133	0.292
脂蛋白(a)	T0	-0.123	0.328
	T1	-0.734	<0.001
	T3	-0.388	0.001
	T7	-0.177	0.158

表4 两组患者麻醉诱导期间不良反应、麻醉情况的比较

组别	例数	低血压[例(%)]	心动过缓[例(%)]	麻醉诱导时长(s,±s)	术后恶心呕吐[例(%)]	苏醒时间(min,±s)
S组	40	4(10.0)	5(12.5)	214.5±39.8	3(7.5)	8.4±2.2
P组	40	12(30.0)	10(25.0)	147.7±27.0	7(17.5)	7.9±1.9
t/χ²值		5.000	2.051	8.784	1.829	1.088
P值		0.025	0.152	<0.001	0.176	0.280

表4 两组患者麻醉诱导期间不良反应、麻醉情况的比较

组别	例数	低血压[例(%)]	心动过缓[例(%)]	麻醉诱导时长(s,±s)	术后恶心呕吐[例(%)]	苏醒时间(min,±s)
S组	40	4(10.0)	5(12.5)	214.5±39.8	3(7.5)	8.4±2.2
P组	40	12(30.0)	10(25.0)	147.7±27.0	7(17.5)	7.9±1.9
t/χ²值		5.000	2.051	8.784	1.829	1.088
P值		0.025	0.152	<0.001	0.176	0.280

[1]	Saraiva MR, Rosa I, Claro I. Early-onset colorectal cancer: A review of current knowledge[J]. World J Gastroenterol, 2023, 29(8): 1289-1303.
[2]	Díaz-Gay M, Dos Santos W, Moody S, et al. Geographic and age variations in mutational processes in colorectal cancer[J]. Nature, 2025, 643(8070): 230-240.
[3]	Zhu HY, Yan JL, Zhang M, et al. Anesthesia, Anesthetics, and Postoperative Cognitive Dysfunction in Elderly Patients[J]. Curr Med Sci, 2024, 44(2): 291-297.
[4]	Nešković N, Budrovac D, Kristek G, et al. Postoperative cognitive dysfunction: Review of pathophysiology, diagnostics and preventive strategies[J]. J Perioper Pract, 2025, 35(1-2): 47-56.
[5]	Pang QY, Duan LP, Jiang Y, et al. Effects of inhalation and propofol anaesthesia on postoperative cognitive dysfunction in elderly noncardiac surgical patients: A systematic review and meta-analysis [J]. Medicine(Baltimore), 2021, 100(43): e27668.
[6]	Cao SJ, Zhang Y, Zhang YX, et al. Delirium in older patients given propofol or sevoflurane anaesthesia for major cancer surgery: a multicentre randomised trial[J]. Br J Anaesth, 2023, 131(2): 253-265.
[7]	Shaw A, Teng R, Fasina T, et al. Lipid dysregulation and delirium in older adults: A review of the current evidence and future directions[J]. Brain Res Bull, 2025, 224: 111299.
[8]	Bonfante S, Netto MB, de Oliveira Junior AN, et al. Oxidative stress and mitochondrial dysfunction contributes to postoperative cognitive dysfunction in elderly rats dependent on NLRP3 activation[J]. Metab Brain Dis, 2024, 40(1): 1.
[9]	Zeng K, Long J, Li Y, et al. Preventing postoperative cognitive dysfunction using anesthetic drugs in elderly patients undergoing noncardiac surgery: a systematic review and meta-analysis[J]. Int J Surg, 2023, 109(1): 21-31.
[10]	Zhao J, He C, Fan X, et al. Tripeptidyl peptidase II coordinates the homeostasis of calcium and lipids in the central nervous system and its depletion causes presenile dementia in female mice through calcium/lipid dyshomeostasis-induced autophagic degradation of CYP19A1[J]. Theranostics, 2024, 14(4): 1390-1429.
[11]	Hu X, Ma YN, Xia Y. Association between abnormal lipid metabolism and Alzheimer's disease: New research has revealed significant findings on the APOE4 genotype in microglia[J]. Biosci Trends, 2024, 18(2): 195-197.
[12]	Rajha HE, Hassanein A, Mesilhy R, et al. Apolipoprotein A(ApoA) in Neurological Disorders: Connections and Insights[J]. Int J Mol Sci, 2025, 26(16): 7908.
[13]	Gu L, Shu H, Wang Y, et al. Association of lipid levels with motor and cognitive function and decline in Parkinson's disease[J]. Psychogeriatrics, 2024, 24(4): 802-810.
[14]	Casado Naranjo I, Portilla Cuenca JC, Duque de San Juan B, et al. Association of vascular factors and amnestic mild cognitive impairment: a comprehensive approach[J]. J Alzheimers Dis, 2015, 44(2): 695-704.
[15]	Zhang T, Xu R, Bao L, et al. The Correlation Between Lipoprotein(a) and Cognitive Impairment in Patients With Ischemic Stroke[J]. Br J Hosp Med(Lond), 2025, 86(8): 1-17.
[16]	Gu L, Wang X, Wu Z, et al. The Inhibition of Reactive Oxygen Species Modulator 1 Attenuates Sevoflurane-Induced Neural Injury via Reducing Apoptosis and Oxidative Stress[J]. J Mol Neurosci, 2024, 74(4): 97.
[17]	Öçmen E, Karaçiçek B, Arıöz Bİ, et al. The Role of microRNA in Anaesthetics-induced Brain Injury: A Narrative Review[J]. Turk J Anaesthesiol Reanim, 2025, 53(5): 187-196.
[18]	Xu F, Han L, Wang Y, et al. Prolonged anesthesia induces neuroinflammation and complement-mediated microglial synaptic elimination involved in neurocognitive dysfunction and anxiety-like behaviors[J]. BMC Med, 2023, 21(1): 7.
[19]	Wang T, Wu X, Zhao X, et al. Sevoflurane Alters Serum Metabolites in Elders and Aging Mice and Increases Inflammation in Hippocampus [J]. J Inflamm Res, 2024, 17: 1241-1253.
[20]	Liu P, Zhao S, Qiao H, et al. Does propofol definitely improve postoperative cognitive dysfunction?-a review of propofol-related cognitive impairment[J]. Acta Biochim Biophys Sin(Shanghai), 2022, 54(7): 875-881.

[1]	刘肖雅, 郭珈宜, 成彦, 李峰, 杨艳霞, 高起, 杨玉霞, 岳辰. 虚拟现实运动在膝骨关节炎患者中应用效果的Meta分析[J/OL]. 中华关节外科杂志(电子版), 2026, 20(01): 50-59.
[2]	马池銮, 贾殿军, 魏冬冬, 石亮, 张晓微, 赵悦. 不同分割模式同步推量调强放疗92例肺癌脑转移的临床研究[J/OL]. 中华肺部疾病杂志(电子版), 2026, 19(01): 76-82.
[3]	黄立政, 王玉倩, 姜金兰, 韩方雷. 间充质干细胞改善术后认知功能障碍的作用机制与研究进展[J/OL]. 中华细胞与干细胞杂志(电子版), 2026, 16(01): 45-51.
[4]	于子清, 李多, 王欢, 武雪亮, 樊建春, 韩笑. STRA6、CYP24A1、NXPH4在结直肠癌肝转移中的表达及意义[J/OL]. 中华结直肠疾病电子杂志, 2026, 15(01): 58-66.
[5]	何睿, 刘昀坤, 孙陈, 田宏亮. 肠道微生态疗法在结直肠肿瘤治疗中的应用[J/OL]. 中华结直肠疾病电子杂志, 2026, 15(01): 67-71.
[6]	中国医师协会结直肠肿瘤专业委员会, 中国抗癌协会NOSES专业委员会, 中国NOSES联盟. 老年结直肠肿瘤经自然腔道取标本手术（NOSES）指南[J/OL]. 中华结直肠疾病电子杂志, 2026, 15(01): 17-30.
[7]	吕钗, 吴子坤, 朱文溥, 赵卫杰, 陈广龙, 艾慧晗, 杨行, 鲍邦和, 刘发强, 李智. 全结肠切除术治疗家族性腺瘤性息肉病相关结直肠癌的预后分析[J/OL]. 中华结直肠疾病电子杂志, 2026, 15(01): 45-57.
[8]	潘胜淇, 李兴源, 王佳琦, 关竣庭, 丁可, 常泽文, 汤庆超. 三臂与四臂达芬奇机器人手术系统在乙状结肠与中高位直肠癌根治术中应用的近期疗效比较[J/OL]. 中华结直肠疾病电子杂志, 2025, 14(06): 509-515.
[9]	张宇坤, 王春林, 周珉玮, 李震洋, 周易明, 顾晓冬, 项建斌. 放疗诱导微卫星稳定型结直肠癌细胞外泌体成分变化及其增强CD8⁺T细胞功能的体外研究[J/OL]. 中华结直肠疾病电子杂志, 2025, 14(06): 526-532.
[10]	张金珠, 陈海鹏, 赵志勋, 王锡山. 耗竭性CD8⁺T细胞表型对结直肠癌免疫检查点阻断剂疗效的影响[J/OL]. 中华结直肠疾病电子杂志, 2025, 14(06): 533-537.
[11]	王思远, 刘馨, 曹永丽, 李明, 张远耀, 魏东. 经自然腔道取标本手术在结直肠肿瘤中无菌与无瘤技术的研究进展[J/OL]. 中华结直肠疾病电子杂志, 2025, 14(06): 538-545.
[12]	宋柯瑾, 李文星. 肿瘤相关中性粒细胞在结直肠癌中的双重调控作用及临床意义[J/OL]. 中华结直肠疾病电子杂志, 2025, 14(06): 546-551.
[13]	韩静, 李西羊, 张桂芝. 不同浓度罗哌卡因超声引导下腹横肌平面阻滞在结直肠癌术后镇痛中的效果对比[J/OL]. 中华消化病与影像杂志(电子版), 2026, 16(01): 79-85.
[14]	侯芳红, 贺修宝. 超声介导的雷公藤甲素外泌体靶向给药系统抗结直肠癌的应用评估[J/OL]. 中华消化病与影像杂志(电子版), 2026, 16(01): 13-20.
[15]	后慧婷, 吴静, 韩柳, 谭玉勇, 刘德良. 湖南省公立医院消化道早癌检出比例现状[J/OL]. 中华胃肠内镜电子杂志, 2026, 13(01): 45-51.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Role of lipid metabolism in sevoflurane and propofol anesthesia on cognitive function in elderly patients with colorectal cancer

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Role of lipid metabolism in sevoflurane and propofol anesthesia on cognitive function in elderly patients with colorectal cancer