麻醉深度对中老年患者术后认知功能及外周血高迁移率族蛋白B1的影响  

Effects of depth of anesthesia on postoperative cognitive function and HMGB1 in peripheral blood in middle-aged and elderly patients

作　　者：陈佳[1] 全承炫[1] 汤观秀[1] 王彤[1] 刘畅[2] 段开明[1] 童建斌[1] 郭曲练[2] 欧阳文[1] 

机构地区：[1]中南大学湘雅三医院麻醉科,长沙市410013 [2]中南大学湘雅医院麻醉科

出　　处：《临床麻醉学杂志》2015年第3期238-242,共5页Journal of Clinical Anesthesiology

基　　金：国家自然科学基金(81371216);中南大学湘雅三医院"125人才工程"资助项目

摘　　要：目的探讨全凭静脉麻醉下麻醉深度对中老年患者术后认知功能及外周血高迁移率族蛋白B1（HMGB1）和IL-1β的影响。方法选取择期胃肠道剖腹手术的中老年患者150例,年龄50-70岁,BMI 18-25kg/m2,ASAⅠ或Ⅱ级,随机均分为两组：深麻醉组（D组）和浅麻醉组（L组）。D组术中BIS值80%以上维持在30-45,L组BIS值80%以上维持在45-60。两组患者均于麻醉诱导前（T1）、术毕（T2）、术后1d（T3）、2d（T4）抽取外周静脉血,用ELISA法测定血浆中的HMGB-1、IL-1β的浓度。分别于术前1d、术后7d、术后3个月对患者进行神经心理学测试。结果共107例患者完成了术后7d神经心理学测试,其中D组53例,L组54例;共59例患者完成了术后3个月神经心理学测试,其中D组29例,L组30例。D和L组术后7d认知功能障碍（POCD）发生率分别为9例（17.0%）和19例（35.2%）,D组POCD发生率明显低于L组（P〈0.05）;D组术后3个月POCD发生率为2例（6.9%）,L组为4例（13.3%）,两组差异无统计学意义。T3、T4时D组HMGB1浓度明显低于L组（P〈0.05）,两组患者不同时点IL-1β差异无统计学意义。结论全凭静脉麻醉下将麻醉深度维持在BIS值30-45的水平能降低胃肠道剖腹术中老年患者的早期POCD发生率,但对远期认知功能影响不大,其发生机制可能与抑制HMGB1的释放,降低围术期炎症反应有关。Objective To investigate the effects of depth of total intravenous anesthesia on postoperative cognitive function and the expressions of high mobility group box-1（HMGB1）and interleukin 1β（IL-1β）in peripheral blood in middle-aged and elderly patients.Methods One hundred fifty patients aged 50-70 years old,BMI 18-25kg/m2,ASA Ⅰ orⅡ,scheduled to receive gastrointestinal surgery were randomly divided into two groups：deep anesthesia group（group D）and light anesthesia group（group L）.The BIS more than 80% were maintained in 30-45 in group D and 45-60 in group L during the operation.The peripheral venous blood was collected before induction of anesthesia（T1）,end of surgery（T2）,1dafter surgery（T3）,2dafter surgery（T4）,and plasma levels of HMGB1 and IL-1beta were correspondingly measured using ELISA.Neuropsychological tests were performed preoperatively,at 1week and 3months postoperatively.Results Totally 107 patients completed both preoperative and postoperative 7days neuropsychological tests,of which 53 were in group D and 54 were in group L.Among them,59 patients completed the neuropsychological tests at 3months after sugery,of which 29 were in group D and 30 were in group L.Postoperative cognitive dysfunction（POCD）occurred in 9patients（17.0%）in the group D and in 19patients（35.2%）in the group L at 7days after surgery.The incidence of POCD in the group D was significantly lower than that in the group L（P〈0.05）.Three months after surgery,POCD occurred in 2patients（6.9%）in the group D and in 4patients（13.3%）in the group L,and there was no statistic difference in the two groups.The plasma levels of HMGB1 at T3,T4 were lower in group D than that in group L（P〈0.05）and there was no statistic difference between groups in the plasma levels of IL-1βat each time point.Conclusion The study show that the depth of total intravenous anesthesia which maintained at a BIS target of 30-45 can reduce the incidence of early POCD,but it has little effect on the long-term

关 键 词：术后认知功能障碍 麻醉深度 脑电双频指数 高迁移率族蛋白B1 白细胞介素1Β 

分 类 号：R614[医药卫生—麻醉学]