丙泊酚及七氟醚麻醉对行颈动脉内膜剥脱术老年患者术后认知功能及氧化应激状态的影响比较  

Comparison the effect of Propofol with Sevoflurane Anesthesia on the Cognitive Function and Oxidative Stress After Carotid Endarterectomy in Elder Patients

作　　者：孔萃萃[1] 王天龙[1] 

机构地区：[1]首都医科大学宣武医院麻醉科,北京100053

出　　处：《北京医学》2017年第6期573-577,共5页Beijing Medical Journal

摘　　要：目的探究丙泊酚及七氟醚在颈动脉内膜剥脱术(Carotid Endarterectomy,CEA)中对脑缺血再灌注损伤的抗氧化应激作用及其对老年患者术后认知功能的影响。方法选取2013年-2016年在我院行择期全身麻醉下颈动脉内膜剥脱术(不需术中转流)的老年患者(65~76岁)47例,随机选用丙泊酚(P组,n=24)或七氟醚(S组,n=23)作为术中麻醉维持用药。(1)术前及术后2 h、24 h分别使用MMSE量表评估患者认知功能状态。(2)在颈动脉夹闭前及夹闭后5 min分别采集患者桡动脉及锁骨下静脉血,并于手术后24 h采集患者外周静脉血。分别检测血样中乳酸、S100B浓度;丙二醛/低密度脂肪酸比率(malondialdehyde/low-density lipoprotein,MDA/LDL);硝酸盐+亚硝酸盐浓度。结果 (1)P组患者术后24 h MMSE评分显著高于S组(P<0.05),(2)P组乳酸、S100B、丙二醛/低密度脂肪酸比率;硝酸盐+亚硝酸盐浓度均低于S组(P<0.05)。结论丙泊酚相比七氟醚可更有效改善CEA老年患者术后认知功能障碍,其机制可能与抑制了缺血再灌注中的氧化应激损伤作用有关。Objective To examine the antioxidant role ofpropofol in ischemia-reperfusion during carotid endarterectomy （CEA） and its influence on cognitive dysfunction after CEA. Methods Forty-seven elder patients （65-76 years old ） who underwent elective CEA under general anesthesia with propofol （group P, n=24）or sevoflurane （group S, n=23） in our hospital between 2013 and 2016 were involved. 1. Cognitive function was assessed with the Mini-Mental State Examination （MMSE） before CEA, 2 hours after CEA, and 24 hours after CEA. 2. Blood samples from the radial artery and the subclavian vein were drawn before carotid clamping and 5 minutes following unclamping, and peripheral blood was obtained 24 hours postoperatively. Samples were analyzed for lactate, S 100B and for the antioxidative markers malondialdehyde/low-density lipoprotein ratio and nitrate ＋ nitrite concentrations. Results Compared with group S, patients in group P exhibited a greater increase in their MMSE values 24 hours postoperatively （P 〈 0.05）. Significantly lower levels of lactate, S100B, malondialdehyde-to-low-density lipoprotein ratio and nitrates/nitrites concentrations were observed during propofol anesthesia. Conclusion Propofol can improve elderly patients＇ cognitive performance after CEA. This improvement is associated with decreased indices of ischemic cerebral damage and maybe due to antioxidative effect in ischemic cerebral circulation.

关 键 词：丙泊酚 颈动脉内膜剥脱术 术后认知功能障碍 氧化应激 

分 类 号：R614[医药卫生—麻醉学]