血清S100β蛋白水平与丙泊酚及依托咪酯麻醉后幼儿早期认知功能障碍的相关性研究  

Correlation of the serum S100β protein level with early postoperative cognitive dysfunction in infants after propofol or etomidate anesthesia

作　　者：蒋奕红[1] 谢景远 熊威威[1] 黄志华[1] 李爱国[1] 谭毅[1] 彭凌云[1] 

机构地区：[1]桂林医学院附属医院麻醉科,桂林医学硕士541001

出　　处：《医学研究生学报》2015年第8期824-828,共5页Journal of Medical Postgraduates

基　　金：广西壮族自治区高等学校科研项目(201204LX243);桂林市科学研究与技术开发计划项目(20140310-2-3)

摘　　要：目的目前临床上缺乏术后认知功能障碍（postoperative cognitive dysfunction,POCD）客观的诊断方法。文中通过比较丙泊酚及依托咪酯麻醉对患儿术后早期认知功能及血清S100β蛋白水平的影响,探讨其间相关性。方法收集桂林医学院附属医院2013年7月至2014年11月1~3岁行腹腔镜下疝修补术患儿的病例资料。排除既往有系统疾病、术后发生并发症等任何影响认知功能评估或不能配合完成全程测试的患儿。将最终纳入的100例资料采用单纯随机法分为丙泊酚麻醉组（丙泊酚组）和依托咪酯麻醉组（依托咪酯组）各50例。2组患儿均于术前1 d及术后3 d采用贝莉婴患儿认知量表Ⅲ按月龄进行相应年龄段的认知功能评估,并均按照Z计分法进行POCD诊断。根据患儿是否发生POCD将每组进一步分为POCD和NPOCD 2个亚组。同时丙泊酚组和依托咪酯组患儿分别于术前（T0）、出麻醉恢复室前（T1）抽取髂内静脉血5 m L,酶联免疫吸附法检测血清S100β蛋白浓度;比较2组组内及组间POCD和NPOCD患儿血清S100β蛋白水平的改变。结果1丙泊酚组和依托咪酯组术后3 d分别有10（20.0%）和9（18.0%）名患儿发生POCD,组间POCD发生率比较差异无统计学意义（P〉0.05）;2与T0比较,2组患儿T1时血清S100β蛋白含量均升高,差异有统计学意义（P〈0.05）;与NPOCD患儿比较,2组POCD患儿血清S100β蛋白含量均明显升高,差异有统计学意义（P〈0.05）;组间比较,T1时NPOCD患儿和POCD患儿血清S100β蛋白含量差异均无统计学意义（P〉0.05）;3丙泊酚组与依托咪酯组患儿术毕血清S100β蛋白含量与术后3 d发生POCD相关（r=0.842,P=0.001;r=0.821,P=0.001）。结论丙泊酚或依托咪酯麻醉后可引起1~3岁患儿术后出现不同程度的认知功能下降。患儿麻醉后血清S100β蛋白含量升高与术后早期发生POCD具有正相关性,血清S100β蛋白含量升高能间接反映麻醉后患儿发�Objective There is a lack objective methods for the diagnosis of postoperative cognitive dysfunction （POCD）. This study aimed to investigate the influence of propofol or etomidate anes- thesia on the postoperative cognitive function and serum S100β protein level in infants. Methods This study included 100 hernia infants aged 1 -3 years treated by laparoseopie hernJorrhaphy under propofol（ n = 50） or etomidate anesthesia （ n = 50）. At 1 day before and 3 days after surgery, we assessed the cognitive function of the patients using Bayley Scales of Infant and Toddler Development （BSID-Ⅲ） and further divided each group into a POCD and a non-POCD sub- group based on the results of diagnosis made according to the Z-scores. Using ELISA, we measured the levels of the serum S100β pro- tein in the iliac venous blood drawn preoperatively （T0 ） and before PACU （T1 ） and compared them between the POCD and non-POCD groups. Results At 3 days after operation, POCD was observed in 10 cases （20.0%） in the propofol group and 9 cases （ 18.0% ） in the etomidate group, with no statistically significant differences between the two （P 〉 0.05）. The level of the serum S100β protein was markedly elevated in both the propofol and etomidate groups at T1 as compared with that at To （P 〈 0.05 ）, and so was it in the POCD in comparison with that in the non-POCD group （P 〈 0.05 ）, with no statistically significant differences between the two groups at T1 （ P 〉 0.05 ）. A significant correlation was found between the postoperative S10013 level and POCD at 3 days after surgery in both the propofol （r=0.842, P=0.001） and the etomidate group （r=0.821, P=0.001）. Conclusion Propofol and etomidate anes- thesia can induce different degrees of postoperative decline of cognitive function in 1 - 3 years old infants. The post-anesthesia elevation of the serum S100β protein level is positively correlated with early postoperative POCD and indicates various degrees of brain damage.

关 键 词：丙泊酚 依托咪酯 患儿 S100Β蛋白 术后认知功能障碍 

分 类 号：R749[医药卫生—神经病学与精神病学]