不同麻醉法对老年冠心病患者冠状动脉旁路移植术后认知功能的影响  

Effects of different anesthesia on cognition function in geriatric patients following off-pump coronary artery bypass grafting

作　　者：李蕾[1] 类维富[1] 费剑春[1] 晁储璋[1] 

机构地区：[1]山东大学附属齐鲁医院麻醉科,济南250012

出　　处：《中华老年心脑血管病杂志》2010年第11期1002-1004,共3页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：山东省卫生厅课题(2007HW026)

摘　　要：目的探讨不同麻醉方法对老年冠心病患者非体外循环冠状动脉旁路移植术术后认知功能和血浆S100β蛋白浓度的影响。方法选择择期行冠状动脉旁路移植术的老年冠心病患者30例,随机分为异氟烷静吸复合麻醉组(A组,1 5例)和丙泊酚全凭静脉麻醉组(B组,15例)。2组患者分别于手术前1 d、术后第4天进行简易智能状态检查量表(MMSE)评分;在术前、缝皮时、术后第1天采血,测定血浆S100β蛋白浓度。结果 A组患者术后出现认知功能障碍5例(33%),B组3例(20%)。与术前比较,A组和B组患者术后第4天MMSE评分明显降低,且A组术后第4天较B组降低更明显。A组和B组患者缝皮时和术后第1天血浆S100β蛋白浓度较术前明显升高(P<0.01)。A组患者缝皮时和术后第1天血浆S100β蛋白浓度明显高于B组(P<0.05)。结论全凭静脉麻醉术后认知功能障碍的发生率和血浆S100β蛋白浓度变化幅度均低于异氟烷静吸复合麻醉,提示丙泊酚全凭静脉可能更适合老年冠心病患者非体外循环冠状动脉旁路移植术的麻醉药物的临床选择。Objective To compare the postoperative cognition function and serum S100β protein levels in geriatric patients following off-pump coronary artery bypass grafting with different anesthesia methods. Methods Thirty ASA physical status Ⅱ-Ⅲ aged patients undergoing off-pump coronary artery bypass grafting were randomly assigned to isoflurane inhalation group（group A, 15） and propofol intravenous group（group B, 15）. The mini-mental state examination（MMSE） was used to assess the cognitive function before and 4 days after the operation. The radial arterial blood was taken at three time points to measure the blood concentration of S100β protein. Results Five patients suffered postoperative cognitive dysfunction in group A（33%）, and 3 cases in group B（20%）. The MMSE score on 4th day in groups A and B obviously reduced,and the score in group A was lower. The serum concentration of S100β after the operation in the two groups was higher than that before the operation,and was higher in group A at the end of the operation and 1 day after operation than that in group B （P〈 0.05）. Conclusion With intravenous anesthesia,postoperative cognitive dysfunction rate and degree of serum S100β protein concentration change are lower than those after inhalation anesthesia for aged patients during off-pump coronary artery bypass grafting. Propofol intravenous anesthesia is more suitable than isoflurane inhalation anesthesia during off-pump coronary artery bypass grafting in old patients.

关 键 词：麻醉药 吸入 麻醉药 静脉 冠状动脉旁路移植术 非体外循环 认知障碍 冠心病 SlOO蛋白质类 

分 类 号：R614[医药卫生—麻醉学]