瑞芬太尼控制性降压对老年脊柱手术患者术后认知功能障碍和血清S100β蛋白的影响及二者相关性分析  

Effects of Remifentanil-induced Controlled Hypotension on Postoperative Cognitive Dysfunction and Serum S100β Protein in Elderly Patients Underwent Spinal Surgery and Relationship Analysis

作　　者：边步荣[1] 刘波[1] 高静[1] 高彦东[1] 高素琴[1] 罗瑞[1] 郭宇峰[1] 韩利锋[1] 

机构地区：[1]榆林市第一医院麻醉科,陕西榆林719000

出　　处：《中国药房》2017年第5期639-642,共4页China Pharmacy

基　　金：榆林市科技计划项目(No.2014jh-20)

摘　　要：目的;观察瑞芬太尼控制性降压(CH)对老年脊柱手术患者术后认知功能障碍(POCD)和血清SlOOβ蛋白的影响,并考察二者的相关性。方法:前瞻性选择2014年1月-2015年12月我院骨科拟择期全身麻醉下行腰椎或胸椎骨折椎板减压内固定术的老年患者60例,采用随机数字表法分为CH组与非CH组,各30例。两组患者均采用气管内插管静脉吸入复合全身麻醉;CH组患者通过调整盐酸瑞芬太尼泵注速率,使平均动脉压(MAP)降至基础值的70%~80%;非CH组则维持MAP基础值。观察两组患者手术时间、麻醉时间、术中失血量、术后POCD发生率、血清S100β蛋白浓度,分析血清S100β蛋白浓度与POCD发生率的相关性,并记录不良反应发生情况。结果:CH组患者术中失血量明显少于非CH组,差异有统计学意义(P<0.05)。两组患者术后第1、7天POCD发生率比较,差异无统计学意义(P>0.05);CH组患者术后第2、3天POCD发生率和血清S100β蛋白浓度均明显高于非CH组,差异均有统计学意义(P<0.05)。患者的POCD发生率可能与血清S100β蛋白浓度存在相关性(r=0.992 7,P=0.001 3)。结论:瑞芬太尼CH用于老年脊柱手术患者,可减少术中失血量,但增加了血清S100β蛋白浓度且升高了术后早期POCD发生率。OBJECTIVE：To observe the effects of remifentanil-induced controlled hypotension（CH） on postoperative cognitive dysfunction（POCD） and serum S100β protein in elderly patients underwent spinal surgery,and to investigate their relationship.METHODS：Sixty elderly patients undergoing selective laminectomy decompression internal fixation of lumbar or thoracic fractures under general anesthesia were selected prospectively from orthopedics department of our hospital during Jan.2014-Dec.2015,and then divided into CH group and non-CH group in accordance with random number table,with 30 cases in each group.Both groups received general anesthesia of injection and inhalation via endotracheal intubation.Mean arterial pressure（MAP） of CH group were reduced to 70%-80%of the basic values by adjusting remifentanil infusion rate;those of non-CH group were maintained at basic level.Surgery duration,anesthesia duration,intraoperative blood loss,the incidence of POCD and serum concentration of S100β protein were observed in 2 groups.The relationship of serum concentration of S100β protein with POCD was analyzed,and the occurrence of ADR was recorded.RESULTS：The intraoperative blood loss of CH group was significantly less than that of non-CH group,with statistical significance（P〈0.05）.There was no statistical significance in the incidence of POCD between 2 groups on the 1st and 7th day after surgery（P〉0.05）.The incidence of POCD and serum concentration of S100β protein in CH group were significantly higher than in non-CH group on the 2nd and 3rd day after surgery,with statistical significance（P〈0.05）.The serum concentration of S100β protein may be related to the incidence of POCD（r=0.992 7,P=0.001 3）.CONCLUSIONS：Remifentanil CH used in elderly patients underwent spinal surgery can reduce intraoperative blood loss,but increase the serum concentration of S100β protein and the incidence of POCD at early stage.

关 键 词：认知功能障碍 全身麻醉 控制性降压 瑞芬太尼 S100Β蛋白 

分 类 号：R614.21[医药卫生—麻醉学]