老年全麻患者围术期血清兴奋性氨基酸浓度的变化及临床意义  

Perioperative change and significience of plasma EAA in senile patients undergoing general anesthesia

作　　者：疏树华[1] 方才[1] 潘建辉[1] 柴小青[1] 王瑞明[1] 陈昆洲[1] 

机构地区：[1]安徽省立医院麻醉科,合肥市230001

出　　处：《临床麻醉学杂志》2011年第1期9-11,共3页Journal of Clinical Anesthesiology

基　　金：安徽省卫生厅临床医学重点学科应用技术项目(编号:05A026)

摘　　要：目的观察老年全麻患者围术期血清兴奋性氨基酸(EAA)浓度的动态变化。方法择期行非心脏手术气管内全麻患者41例,根据年龄不同分为老年组31例,年龄≥65岁;青年组10例,年龄25～45岁。所有患者术后均使用静脉镇痛。采用简易智力状态检查法(MMSE)分别评估患者麻醉前及术后24、48、72h内的认知功能。于麻醉前(T1)、术毕(T2)、术后24h(T3)、48h(T4)、72h(T5)经颈内静脉采血2ml,采用反相高效液相色谱荧光法(RP-HPLC)检测血清氨基酸浓度。结果 MMSE评分老年组术后24、48h明显低于麻醉前和青年组(P<0.05)。与T1时比较,T3、T4时老年组血清谷氨酸(Glu)、天冬氨酸(Asp),甘氨酸(Gly)浓度升高(P<0.05或P<0.01),T5时恢复。T1时老年组血清Glu、Asp、Gly浓度低于青年组,但差异无统计学意义;T3时老年组Glu、Asp、Gly明显高于青年组(P<0.05)。结论老年患者术后早期存在EAA水平升高,Glu可能参与术后认知功能障碍(POCD)的病理生理过程,老年患者全麻术后早期血清EAA水平较高可能是老年POCD发病率高的原因之一。Objective To observe the perioperative change of plasma excitatory amino acids（EAA）in senile patients undergoing general anesthesia during operation and explore its clinical significance.Methods Forty one patients underwent selective surgery under general anesthesia.The patients were divided into two groups according to the age of patients,the old group（31 patients,aged over 65 years）and the young group（10 patients,aged 25 to 45 years）.Venous PCI was operated in all the patients.Cognitive function was evaluated by MMSE before anesthesia and at 72-h postoperatively in all patients.The jugular venous blood samples were taken for the measurement of plasma concentrations of EAA including glutamate（Glu）,aspartate（Asp）and glysine（Gly）at different time-points as before anesthesia（T1,baseline）,the end of surgery（T2）and 24 h（T3）,48 h（T4）,72 h（T5）postoperation.RP-HPLC was used to detect the levels of plasma EAA.Results The score of MMSE in the old group at T3 or T4 was significantly lower than those in the young group or T1.Compared with those at T1,plasma concentrations of Glu,Asp and Gly were significantly increased in old group at T3 and T4（P〈0.05 or P〈0.01）,then to normal at T5.Compared with those in young group,plasma concentrations of Glu,Asp and Gly were significantly increased in old group at T3（P〈0.05）.Conclusion In senile patients underwent general anesthesia,plasma concentrations of EAA increased in the early time post-operation,Glu could involve in the pathophysiologic process of postoperative cognitive dysfunction（POCD）.

关 键 词：兴奋性氨基酸 术后认知功能障碍 老年 

分 类 号：R614[医药卫生—麻醉学]