全麻老年患者围术期血浆β-淀粉样蛋白1-40的变化及其意义

Perioperative change and significience of plasma Aβ(1-40) in elder patients undergoing general anesthesia

目的观察全麻老年患者围术期血浆β-淀粉样蛋白1-40[Aβ(1-40)]水平的变化,探讨其与手术后认知功能障碍(POCD)的关系。方法40例择期开腹手术患者按照年龄分为两组:青年组(20例,年龄在20～50岁之间);老年组(20例,年龄≥65岁)。分别在手术前一天和手术后24 h进行简易智能量表(MMSE)评分。于手术前(T1)、手术开始后2 h(T2)、4 h(T3)、24 h(T4)采集静脉血标本,用酶联免疫吸附(ELISA)法测定血浆Aβ(1-40)。结果与手术前相比,老年组手术后MMSE评分明显降低;青年组差异无统计学意义。老年组血浆Aβ(1-40)T1～T4各时点均高于青年组(P<0.05),且在T2～T4时均显著高于T1时(P<0.05)。结论老年人血浆Aβ(1-40)基础水平较高且手术开始后24 h持续维持于较高水平,可能是老年人POCD发生率高的原因之一。

Objective To observe the perioperative change of plasma beta-amyloid protein （1-40）[Aβ（1-40）] in elder patients undergoing general anesthesia and explore its correlation with postoperative cognitive dysfunction （POCD）. Methods Forty patients underwent selective major upper abdominal surgery were divided into two groups of young group aged from 20 to 50 years old and elder group older than 65 years. MMSE evaluation was made one day before and one day after operation. Venous blood samples were taken for the measurement of plasma Aβ （1-40） before operation （T1）, at 2 h （T2）, 4 h （T3）, and 24 h （T4） during operation. Results There was a significant decrease in MMSE evaluation scale at T2-T4 compared with that at T1 in elder group,which was not in young group. The level of plasma Aβ（1-40）in elder group was significantly higher than that in young group at T1. There was a significant increase in plasma Aβ（1-40） at T2 ,T3 and T4 compared with that at T1 in elder group. Conclusion High basal level of plasma Aβ（1-40）was seen in elder patients, which may be one of the factors related to POCD.