七氟醚与丙泊酚复合麻醉对心内直视术患者S-100β蛋白、NSE和认知功能影响的比较  

Comparison of effects of sevoflurane and propofol combined anesthesia on S-100β protein,neuron-specific enolase and postoperative cognitive function in patients with cardiac surgery

作　　者：涂杰[1] 张炳东[1] 韦秋英[1] 李涛[1] 刘国锋[1] 刘菊梅[1] 

机构地区：[1]广西医科大学第一附属医院心血管病研究所导管手术麻醉室,南宁530021

出　　处：《广东医学》2013年第24期3735-3738,共4页Guangdong Medical Journal

基　　金：广西壮族自治区卫生厅自筹经费科研课题(编号:Z2012109)

摘　　要：目的 比较七氟醚与丙泊酚复合麻醉对心内直视术患者S-100β蛋白、神经元特异性烯醇化酶（NSE）和认知功能的影响,为减少心内直视术后脑损伤提供参考.方法 择期行心脏二尖瓣置换术患者60例,性别不限,年龄24-63岁,体质指数16.5-25.8 kg/m2,ASA分级Ⅱ或Ⅲ级,随机分为两组（n=30）：七氟醚复合麻醉组（S组）和丙泊酚复合麻醉组（P组）.麻醉诱导：静脉注射咪达唑仑0.05-0.1 mg/kg,依托咪酯0.3-0.5 mg/kg,瑞芬太尼0.5-1 μg/kg,顺苯磺酸阿曲库铵0.15 mg/kg.麻醉维持：S组持续吸入1.0%-3.0%七氟醚（体外循环期间通过体外循环旁路吸入1.0%-3.0%七氟醚）,P组靶控输注2-4 μg/mL丙泊酚;两组均静脉输注瑞芬太尼0.2-0.4 μg/（kg·min）和顺苯磺酸阿曲库铵0.1 mg/（kg·h）至手术结束.于麻醉诱导前（T0）、体外循环开始后30 min（T1）、体外循环结束时（T2）、手术结束时（T3）、术后12 h（T4）及术后24 h（T5）时采集颈内静脉血测定血清S-100β蛋白和NSE浓度,于术前1 d和术后2 d用简易精神状态检查表（MMSE）评估患者的认知功能.结果 与P组比较,S组T1-T4时点血清S-100β蛋白和NSE浓度降低（P〈0.05）,术后2 d时MMSE评分升高（P〈0.05）,术后认知功能障碍（POCD）发生率下降（P〈0.05）.结论 在心内直视术中,与丙泊酚复合麻醉比较,七氟醚复合麻醉可降低血浆S-100β蛋白和NSE浓度,减少术后POCD的发生,可推荐为预防心内直视术后脑损伤的麻醉方法.Objective To compare the effects of sevoflurane and propofol combined anesthesia on S - 10013 protein, neuron - specific enolase （NSE） and postoperative cognitive function in patients with cardiac surgery, thus to reduce brain injury after cardiac surgery. Methods Sixty ASA Ⅱ or m patients with mitral valve replacement were randomly di- vided into two groups （ n = 30 ） ： sevoflurane combined anesthesia group （ Group S ） and propofol combined anesthesia group （Group P）. Anesthesia was induced with midazolam, etomidate, remifentanil and cisatraeruium. Anesthesia was maintained with 1.5% - 3.0% sevoflurane （during cardiopulmonary bypass, 1.5% - 3.0% sevoflurane was washed into extracorporeal circuit） in Group S, and 2 - 4 μg/mL propofol in Group P. Combined infusion of remifentanil at 0. 2 -0.4 μg/（ kg · rain） and cisatraeruium at 0. 1 mg/（ kg · h） was given in both groups until the end of operation. Blood samples were taken from central vein before induction of anesthesia （TO, baseline）, at 30 min of cardiopulmonary bypass （T1）, at the end of cardiopulmonary bypass （T2）, at the end of operation （T3）, and 12 （T4）, 24 h （T5） after operation for determination of serum concentration of S - 100β protein and NSE. The cognitive function was assessed 1 day before operation and 2 days after operation by mini - mental state examination （MMSE）. Results Serum concentration of S - 100β protein and NSE were significantly lower at T1 - T4 in Group S than those in Group P （ P 〈 0. 05 ） , and higher MMSE score with lower incidence of postoperative cognitive dysfunction （POCD） 2 days after operation （P 〈 0. 05 ）. Conclusion Sevoflurane combined anesthesia can reduce serum concentration of S - 100β protein and NSE, and lower the incidence of POCD in patients with cardiac surgery than that of propofol combined anesthesia, which is a recommendable anesthesia method that could be used to prevent brain injury after cardiac surgery.

关 键 词：七氟醚 丙泊酚 S-100Β蛋白 神经元特异性烯醇化酶 认知功能 

分 类 号：R749[医药卫生—神经病学与精神病学]