Effects of combined spinal-epidural anesthesia on oxidative stress and cognitive function in elderly patients with fracture and its effect on Keap1-Nrf2 pathway
Objective To analyze the effect of combined spinal-epidural anesthesia in elderly patients with fracture and its influence on the activity of kelch like ECH associated protein 1(Keap1)-nuclear factor erythroid 2-related factor 2(Nrf2)signaling pathway.Methods Totally 100 elderly patients with fracture treated by orthopedic surgery were divid-ed into control group(n=50)and observation group(n=50)by random number table method.The control group was given general anesthesia,and the observation group was given combined spinal-epidural anesthesia,the postoperative outcomes and Keap1-Nrf2 pathway activity of the two groups were compared.Results At 5 min(T1)and 15 min(T2)after anesthesia,compared with the control group,the heart rate(HR)in the observation group was lower and the average arterial pressure(MAP)was higher.At 24 h after operation,the MMSE score of the observation group(25.31±1.32)was higher than that of the control group(24.66±1.26)(P＜0.05).At 24 h after operation,the malondialde-hyde(MDA)in the observation group(8.42±2.01)was lower than that in the control group(10.34±2.25).and the level of SOD in the observation group(89.35±18.31)was higher than that in the control group(76.47±17.95)(P＜0.05).At 24 h after operation,the Keap1 protein in the peripheral blood of the observation group was lower than that of the control group,and the Nrf2 protein level in the peripheral blood was higher than that of the control group(P＜0.05).Compared with the control group,the postoperative recovery time of patients in the observation group was significantly shortened(P＜0.05).And the incidence of complications in the observation group was lower(2％vs 8％)(P＞0.05).Conclusion Combined spinal-epidural anesthesia can activate Keap1-Nrf2 antioxidant stress pathway,reduce the risk of stress reaction and postoperative cognitive impairment,and has a relatively stable hemodynamics for patients,which is beneficial to postoperative recovery,safe and worth popularizing.
General anesthesiaCombined spinal-epidural anesthesiaOld ageFractureOxidative stressKeapl-Nrf2 pathway
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