异丙酚和异氟醚对脑肿瘤切除术后认知和β淀粉样蛋白的影响

Effects of propofol and isoflurane anesthesia on cognitive function and β amyloid level in patients after brain tumor resection

目的探讨异丙酚和异氟醚对脑肿瘤切除术患者术后早期认知功能和β淀粉样蛋白（A13）的影响。方法选择全麻下行脑肿瘤切除术的老年患者50例，随机数字表法分为异丙酚和异氟醚组，每组25例。麻醉诱导后前组患者静脉靶控输注异丙酚（效应室靶浓度为3-4μgmL），后组患者吸入1．2％异氟醚，并且均间断静注维库溴铵（0．02～0．03mg／kg．h）、芬太尼（1～2μg／kg．h）维持麻醉深度。术前1d、术后1～3d分别采用简易智力量表（MMSE）NIELISA法测定患者的认知功能和血浆β淀粉样蛋白1-40（Aβ1-40）水平的变化。结果异丙酚组和异氟醚组患者术后1～3d分别有8例（32％）和11例（44％）发生POCD，差异无统计学意义（χ2=0．764，P=0．382）。术后1～3d两组患者血浆Aβ1-40浓度均较术前均明显升高，异丙酚组术后3dAβ1-40浓度低于术后2d，差异有统计学意义（p〈0．05）；与异丙酚组同一时间点比较，异氟醚组血浆1β1-40浓度较高，差异有统计学意义（p〈0．05）。结论与异氟醚比较，异丙酚麻醉后脑肿瘤切除术患者血浆Aβ1-40的升高幅度较低，恢复较快。

Objective To investigate the etlects ot propofol and lsotlurane anesthesla on cognitive function and βamyloid （Aβ） level in patients after brain tumor resection. Methods Fifty patients performed tumor resection were randomly divided into propofol （n=25） and isoflurane treatment groups （n=25）. After anesthesia induction, propofol （target effect： 3-4 μg/mL） was intravenously injected into the patients of propofol treatment group and 1.2% isoflurane was inhaled into the patients of the isoflurane treatment group, respectively. In addition, vecuronium （0.02-0.03 mg/kg, h） and fentanyl （1-2 μg/kg, h） were intravenously intermittently injected into the patients of the 2 groups to maintain the depth of anesthesia. The cognitive function and Aβ1-40 level in these patients were detected, respectively, before operation, 1, 2 and 3 d after operation, by mini-mental state examination （MMSE） and ELISA. Results Eight patients （32%） in the propofol treatment group and 11 patients （44%） in the isoflurane treatment group occurred postoperative cognitive dysfunction 1, 2 and 3 d after operation; no significant difference was noted between these 2 groups （X2=0.764, P=-0.382）. Aβ1-40 levels in the blood of patients in the 2 groups 1, 2 and 3 d after operation were significantly increased as compared with those before operation （P〈0.05）; Aβ1-40 level in the blood of patients in the propofol treatment group 3 d after operation was significantly lower than that 2 d after operation （P〈0.05）. Aβ1-40 content in the isoflurane treatment group was significantly higher at each time point as compared with that in the isoflurane treatment group （P〈0. 05）. Conclusion The increase extent of Aβ1-40 level caused by propofol anesthesia in blood of patients after brain tumor resection is lower and its recovery time is faster than those caused by isoflurane anesthesia.