七氟醚与异丙酚对老年人腹部手术术后认知功能的影响  

Effect of sevoflurane and propfol on postoperative cognitive function in elderly patients recepted abdominal surgery

作　　者：陈贵珍[1] 鲁开智[1] 王恩琴[1] 唐希[1] 顾健腾[1] 崔剑[1] 陶国才[1] 

机构地区：[1]第三军医大学西南医院麻醉科,重庆400038

出　　处：《重庆医学》2010年第17期2287-2289,共3页Chongqing medicine

摘　　要：目的探讨七氟醚与异丙酚对老年人腹部手术术后认知功能的影响及S100β蛋白与术后认知功能障碍（POCD）的相关性。方法选择择期行腹腔镜下腹部手术的ASAⅠ-Ⅱ级老年患者40例,随机分为七氟醚组（S组）和异丙酚组（P组）,每组20例。麻醉诱导后分别予1-1.3 MAC七氟醚（S组）和靶控输注2-4μg/mL异丙酚（P组）麻醉维持。记录手术结束后自主呼吸恢复时间、轻唤睁眼时间及拔管时间,于麻醉前、术后1、3、6、12、244、8 h采用简易智力状态检查表（MMSE）评价认知功能,并测定术前及术后1、62、4 h的血清S100β蛋白。结果两组患者术后自主呼吸恢复时间、睁眼时间、拔管时间及术前MMSE评分比较均差异无统计学意义（P〉0.05）。与术前基础值比较,P组患者术后13、h和S组术后1、36、h MMSE评分均有明显下降（P〈0.05）,且S组术后13、h MMSE评分较P组低（P〈0.05）。P组患者术后12 h已恢复至术前水平。S组术后24 h仍有1例患者存在POCD。两组患者术前S100β比较无差异。与术前基础值比较,P组和S组术后1 h S100β蛋白测定值均有明显升高（P〈0.01）,且S组术后16、h S100β蛋白测定值均较P组高（P〈0.05）,但P组术后6 h S100β蛋白测定值基本回落到术前基础值水平（P〉0.05）,S组术后6 h S100β蛋白测定值虽有下降,但仍较测定的基础值有升高（P〈0.05）。术后24 h两组S100β蛋白测定值回落到接近基础值水平,组间差异无统计学意义（P〉0.05）。结论七氟醚与异丙酚均能引起老年人术后早期认知功能障碍,但七氟醚对认知功能的影响更大,持续时间更长;血清S100β蛋白浓度与早期POCD发生有一定相关性。Objective To investigate the influence of sevoflurane and propofol on post-operative cognitive dysfunction in the elderly patients and to evaluate the correlation between protein S100β and POCD.Methods Forty ASAI-II patients undergoing lower abdominal surgery under laparoscope were randomly assigned to two groups,group sevoflurane（group s,n=20） and group propofol（group p,n=20）.After the induction of anesthesia,1-1.3 MAC sevoflurane（group s） and propofol（group p）2-4 μg/mL（TCI） were given for anesthetic maintenance.The time for spontaneous breath,eye opening and extubation after the operation were recorded.The mimi-mental state examination（MMSE） was used to assess the cognitive function before and 1,3,6,12,24 h and 48 h after the operation.The concentration of protein S100β before and 1 h,6 h and 24 h after the operation were determined.Results The time for spontaneous breath,eye opening and extubation had no difference.Compared with the preoperative values,MMSE scores were significantly reduced at 1,3 h and 6 h in group s and at 1h and 3h in group p（P〈0.05）,and MMSE scores at 1 h and 3 h in group s were lower than those in group p（P〈0.05）.The MMSE scores at 12h in group P returned to baseline,but one patient in group S still had POCD.Compared with the preoperative values,the S100β at 1h in both groups were dramatically changed（P〈0.05）,and the values at 1h and 6h in group S were higher than that in group P（P〈0.05）.The S100β at 6h in group P returned to baseline,but in group S,it did not return until 24 h after the operation.Conclusion Sevoflurane and propofol both can result in POCD,and sevoflurane has a more serious extent and a longer effect than propofol;serum protein S100β has a certain correlation with POCD in early stage.

关 键 词：七氟醚 异丙酚 老年 认知功能障碍 

分 类 号：R614[医药卫生—麻醉学]