不同吸入麻醉药对老年患者术后早期认知功能及S100β蛋白表达的影响

Effect of Different Inhalation Anesthetics on Early Cognition Function and S100β in Elderly Patients after Operation

【目的】比较安氟醚、异氟醚与七氟醚三种吸入麻醉药对老年患者术后早期认知功能及血清S100β蛋白表达的影响。【方法】择期行腹部手术老年患者120例,随机分为三组,全身麻醉诱导后分别以安氟醚(A组)、异氟醚(B组)、七氟醚(C组)维持麻醉;分别于麻醉前、术后6h、1、2、3、5d测定患者简易智力状态检查(MMSE)评分及血清S100β蛋白水平。【结果】三组年龄、性别、手术时间、麻醉时间、吸入麻醉药及输液量等差异无显著性(P>0.05);C组患者术后苏醒时间、拔管时间均少于A组及B组(P<0.05)。三组麻醉前MMSE评分组间差异无显著性(P>0.05)。与麻醉前及C组相应时点比较,A组患者术后d1、d2、d3MMSE评分显著降低(P<0.05),B组术后d1、d2MMSE评分显著降低(P<0.05);C组手术前后各时点MMSE评分均无明显变化(P>0.05);三组麻醉前S100β蛋白组间差异无显著性(P>0.05)。与麻醉前及C组相应时点比较,A组患者术后6 h、d1、d2、d3血清S100β蛋白显著增高(P<0.05),B组患者术后6 h、d1、d2血清S100β蛋白显著增高(P<0.05);C组手术前后各时点血清S100β蛋白无明显变化(P>0.05)。【结论】安氟醚与异氟醚均可引起老年患者术后早期认知功能障碍及S100β蛋白表达增高。七氟醚则无明显影响。

[Objective]To compare changes of the post-operative cognitive function and serum S100β after enflurane, isoflurane and sevoflurane anesthesia in elderly patients. [Methods]A total of 120 elderly patients undergoing abdominal surgery under general anesthesia were randomly assigned to three groups. Following the induction,enflurane（group A）, isoflurane（group B） and sevoflurane（group C）were respectively inhaled to maintain anesthesia. Awaking time and extubation after operation were recorded. The mini-mental state examination （MMSE） and serum S100β were used to assess preoperative and postoperative cognitive function at the 6h and 1,2,3,5 days. [Results] There were no significant differences among the three groups in age, sex,body weight,volume of infusion and duration of anesthesia and surgery（ P 〉0.05）. Awaking time and extubation after operation in the group C were shorter than those in group A and group B. The MMSE scores at 1,2,3 day time point in the group A were lower than those in the group C （ P 〈0.05）. The MMSE scores at 1,2 day time point in the group B were lower than those in the group C （ P 〈0.05）. The levels of serum S100β at the 6h and 1,2,3 day in the group A were higher than those in the group C （P〈0.05）. The levels of serum S100β at the 6hr and 1,2 day in the group B were higher than those in the group C （ P 〈0.05）. [Conclusion] Both enflurane and isoflurane anesthesia may contribute to postoperative cognitive dysfunction and the increase of serum S100β in elderly patients. Sevoflurane anesthesia shows no significant effect on postoperative cognitive function and the levels of serum S100β in elderly patients.