血浆稳态氧化氮产物和S-100β蛋白与老年前列腺电切术后认知功能障碍的关系  

Relationship Between Plasma Concentrations of Stable Nitric Oxide Products or S-100 Beta Protein and Cognitive Dysfunction After Transurethral Resection of Postate in Elderly Patients

作　　者：王成夭[1] 章军建[2] 王焱林[1] 王京[1] 

机构地区：[1]武汉大学中南医院麻醉科,湖北武汉430071 [2]武汉大学中南医院神经内科,湖北武汉430071

出　　处：《武汉大学学报（医学版）》2007年第4期426-430,共5页Medical Journal of Wuhan University

基　　金：国家自然科学基金资金资助项目(编号:30270483)

摘　　要：目的:观察全身麻醉经尿道前列腺电切术后老年患者认知功能障碍(POCD)的发病率,研究血浆S-100β蛋白和稳态氧化氮产物浓度与POCD的关系。方法:选择40例ASAⅠ-Ⅱ级年龄68-82岁患者,择期进行经尿道前列腺电切术。在术前1 d,术后4 d和6周进行神经心理学测试,一个或多个认知功能缺陷被确定为认知功能障碍。并在术前和术后不同的时间点测定血浆S-100β蛋白和稳态氧化氮产物浓度。结果:术后4 d,有16例患者发生POCD(40%),术后6周有20例患者发生POCD(50%)。与没有认知功能障碍的患者比较,术后4 d发生POCD患者围术期各时间点血浆稳态氧化氮产物浓度明显增强(P<0.05),而血清S-100β蛋白浓度没有差异。结论:经尿道前列腺电切术老年患者术后POCD发生率为40%-50%,POCD的发生与血浆稳态氧化氮产物浓度相关,与血浆S-100β蛋白浓度无关。Objective： To determine the incidence of postoperative cognitive dysfunction （POCD） after transurethral resection of the postate （TURP） under general anesthesia in old patients and to examine its association with plasma concentrations of S-100 protein and stable nitric oxide （NO） products. Methods： Neuropsychological tests were performed on 40 ASA physical status Ⅰ-Ⅱ patients aged 68-82 years weighing 47-65 kg undergoing general anesthesia at the day before surgery, at 4 d and in the 6th week postoperation. Patient spouses （n= 15） were studied as controls. Cognitive dysfunction was defined when the subject was deficient in one or more cognitive domain （s）. Serial measurements of serum concentrations of S-100 protein and plasma concentrations of stable NO products （nitrate/nitrite, NOx） were performed perioperatively. Results： Four days after surgery, new cognitive deficits were found in 16 （40%） patients. Six weeks postoperatively, new cognitive deficits were found in 20 （50%） patients. Compared with the ＂non-deficit＂ group, patients who demonstrated a new cognitive deficit at 4 d had the highest plasma NOx （P〈0.05）. Serum S-100 protein concentrations were similar between the two groups. Conclusion： Preoperative （and postoperative） plasma concentrations of stable NO products are associated with early POCD. The plasma concentrations of stable NO products represents a potential biochemical predictor of POCD.

关 键 词：术后认知功能障碍 老年患者 前列腺电切术 稳态氧化氮产物 

分 类 号：R749.16[医药卫生—神经病学与精神病学]