七氟烷对老年患者血清同型半胱氨酸与术后认知功能的影响  

The research of the influence of sevoflurane on the homocysteine(Hcy) in serum and the correlation of postoperative cognitive function

作　　者：高烨[1] 张邓新[1] 季永[1] 沈志耘[1] 

机构地区：[1]苏州大学附属第四医院麻醉科,江苏无锡214062

出　　处：《南京医科大学学报（自然科学版）》2011年第11期1632-1635,共4页Journal of Nanjing Medical University(Natural Sciences)

基　　金：江苏省教育厅开放课题项目(KJS09001);无锡市医院管理中心医学科技发展基金项目(YGZ1008)

摘　　要：目的:探讨吸入不同浓度七氟烷对老年患者术后认知功能的影响及血清同型半胱氨酸(homocysteine,Hcy)与术后认知功能障碍(post-operative cognitive dysfunction,POCD)的相关性。方法:选择择期行胃切除术的美国麻醉师协会(ASA)评分Ⅰ～Ⅱ级老年患者60例,随机分为吸入七氟烷低浓度组(A组)和吸入七氟烷高浓度组(B组),每组30例。全麻诱导后分别予1.5%七氟烷(A组)和3.0%七氟烷(B组)吸入麻醉维持。于麻醉前、术后6、24、72 h采用简易智力状态检查表(MMSE)评价认知功能,并测定术前、术中2 h及术后24、72 h的血清Hcy。结果:术前MMSE评分比较无统计学意义(P>0.05)。与术前基础值比较,A、B两组患者术后6 h MMSE评分均有明显下降(P<0.05),且B组术后6 h MMSE评分较A组低(P<0.05)。两组患者术前血清Hcy比较无差异。与术前基础值比较,A组术中2 h、术后24、72 h血清Hcy测定值虽有升高但无统计学意义(P>0.05),B组术中2 h血清Hcy测定值较术前基础值有明显升高(P<0.05),但B组术后24、72 h血清Hcy测定值基本回落到术前基础值水平(P>0.05)。结论:吸入高浓度七氟烷较吸入低浓度七氟烷更易引起术后认知功能障碍。血清Hcy浓度与七氟烷的吸入浓度存在相关性。Objective： To investigate the influence of inhaling different concentration of sevoflurane on post-operative cognitive dysfunction（POCD） in the elderly patients and evaluate the correlation between serum of homocysteine（Hcy） and POCD.Methods： Sixty ASA Ⅰ～Ⅱ patients undergoing lower gastrectomy were randomly assigned to two groups,group A inhaling low concentration of sevoflurane（n = 30） and group B inhaling high concentration of sevoflurane（n = 30）.After the induction of anesthesia,1.5% sevoflurane（group A） or 3.0% sevoflurane（group B） were given for anesthetic maintenance.The mimi-mental state examination（MMSE） was used to assess the cognitive function before and 6,24,72 h after the operation.The serum Hcy before and 2 h in the operation and 24,72 h after the operation were determined.Results： The difference of MMSE scores between two groups before the operation were insignificant（P 0.05）.Compared with the preoperative values,MMSE scores were significantly reduced at 6 h in two groups（P 0.05）,which is lower in group B than group A（P 0.05）.Compared with the preoperative values,the serum Hcy at 2 h in the operation and 24,72 h after the operation in group A increased insignificantly（P 0.05）,while the serum Hcy at 2 h in the operation in group B increased significantly（P 0.05）,and returned to baseline at 24,72 h after the operation（P 0.05）.Conclusion： Inhaling high concentration of sevoflurane was easier to result in POCD than inhaling low concentration of sevoflurane.Serum Hcy level was related to the concentration of inhaling sevoflurane.

关 键 词：七氟烷 浓度 血清 同型半胱氨酸 老年 认知功能障碍 

分 类 号：R614.2[医药卫生—麻醉学]