术后认知功能障碍与α1-抗糜蛋白酶表达的临床研究  

Relationship between postoperative cognitive dysfunction and the expression ofα1-antichymotrypsin in plasma

作　　者：施丽燕[1] 徐静[1] 万燕杰[1] 张传青[2] 陈海军[2] 

机构地区：[1]上海市浦东新区公利医院疼痛科,200135 [2]江苏省麻醉学重点实验室江苏省麻醉医学研究所

出　　处：《临床麻醉学杂志》2014年第7期637-640,共4页Journal of Clinical Anesthesiology

基　　金：浦东新区卫生局卫生科技项目基金(PW2011A-9);浦东新区卫生系统优秀青年医学人才培养计划(PWRq-2012-16);(PWRq-2010-01)

摘　　要：目的研究术后认知功能障碍(postoperative cognitive dysfunction,POCD)与外周血α1-抗糜蛋白酶(α1-antichymotrypsin,α1-ACT)的临床关系。方法随机选择全身麻醉下行普外科手术患者64例,在术前1d、术后7d和术后3月采用成套神经心理测验(battery of cognitive assessment instruments,BCAI)评价患者认知功能,根据结果分为POCD和非POCD。所有患者随机分为乌司他丁组(U组,n=30,于麻醉诱导前30min将10 000U/kg乌司他丁溶于100ml生理盐水中,20min内静滴完毕)和对照组(C组,n=34,给予等容量生理盐水)。在术前1d、术后7d和术后3月分别采血检测α1-ACT。结果术后7d、术后3月两组POCD患者α1-ACT的表达明显高于非POCD患者(P<0.05)。术后7d所有患者α1-ACT的表达均明显高于术前1d(P<0.05)。术前1d POCD与非POCD患者α1-ACT表达差异无统计学意义。U组术后7d、术后3月POCD的发生率明显低于C组(P<0.05)。结论 POCD的发生与血浆中α1-ACT的表达增高有关。Objective To investigate the relationship between the expression ofα1-antichymot-rypsin （α1-ACT）in plasma and postoperative cognitive dysfunction（POCD）.Methods The cognitive function of 64 patients undergoing operation under general anesthesia was evaluated by a battery of cognitive assessment instruments（BCAI）and the levels ofα1-ACT were measured at the time 1 d pre-operatively and 7 d and 3 months postoperatively.The patients were randomly divided into two groups：30 patients in ulinastatin group （group U）were injected with 10 000 U/kg ulinastatin,which was dissolved in 100 ml saline,within 20 min at the time of 30 minutes before induction;while control group （group C）were injected with the same volume saline.Results There was no significant differ-ence between the expression of α1-antichymotrypsin in patients with POCD and in control patients at the time before operation.Compared with control patients,the levels of α1-ACT in patients with POCD at the time of 7 d and 3 months postoperation were significantly higher （P 〈0.05）.The levels of α1-ACT at 7 d postoperation were significantly higher than that preoperatively in both groups （P 〈0.05）.The incidence of POCD in group U were significantly lower than that in group C,at the time of 7 d and 3 months after surgery （P 〈0.05）.Conclusion POCD is associated with high expression of plasma α1-ACT.

关 键 词：术后认知功能障碍 Α1-抗糜蛋白酶 乌司他丁 

分 类 号：R614[医药卫生—麻醉学]