依托咪酯单次诱导给药对老年患者术后认知功能影响的临床研究

Clinical Research of Etomidate Single Induction Administration on Postoperative Cognitive Function in Elderly Patients

目的分析依托咪酯单次诱导给药对老年患者术后认知功能的影响,为临床老年患者的手术麻醉提供参考。方法选择2010年1月至2013年12月重庆医科大学附属永川医院收治的全麻下行手术的老年患者200例,采用随机数字表法分为依托咪酯组和丙泊酚组,术前分别用依托咪酯和丙泊酚进行麻醉诱导,于麻醉诱导前5 min、手术结束时术后12、24、48 h取血测定血浆促肾上腺皮质激素(ACTH)、皮质醇、神经元特异性烯醇化酶(NSE)和S100β蛋白水平;并使用简易精神状态量表检查(MMSE)评估患者术后认知功能障碍。结果与术前相比,依托咪酯组各时点除48 h外ACTH、NSE、S-100β蛋白水平均显著增加,皮质醇水平显著降低(P<0.05),在48 h时均有所恢复(P>0.05);与丙泊酚组相比,依托咪酯组术后各时点除48 h外ACTH、NSE、S100β蛋白水平均显著升高,皮质醇水平显著降低(P<0.05)。与术前比较,两组患者术后1、4、12 h MMSE评分均显著下降(P<0.05),术后24 h以后均有所恢复。结论依托咪酯单次诱导给药,术后老年患者会出现短暂性认知功能衰退,48 h后逐渐恢复,适用于老年患者的麻醉诱导。

Objective To analyze single dose etomidate induction effects on postoperative cognitive function in elderly patients to provide reference for clinical anesthesia in elderly patients.Methods A total of 200 elderly patients with general anesthesia operation admitted to Yongchuan Hospital Affiliated to Chongqing Medical Lniversity from Jan.2010 to Dec.2013 were randomly divided into etomidate group and propofol group according to number-table method,preoperative anesthesia was induced with etomidate and propofol respectively,at the time point of prior to induction of anesthesia,5 min,postoperative 12,24,48 h blood plasma was taken for adrenocorticotropic hormone（ACTH）,cortisol,neuron-specific enolase（NSE）and S-100β protein concentration;postoperative cognitive dysfunction in patients was evaluated with MiniMental state Examination examination（MMSE） assessment.Results Compared with preoperative etomidate group at all time points except 48 h：ACTH NSE S-100β protein levels in plasma were significantly increased,cortisol concentrations were significantly decreased（P 〈 0.05）,while all recovered to different extents at 48 h（P 〉 0.05） ; compared with propofol group,ACTH,NSE,S-100β protein levels of etomidate group were significantly higher at all time points except 48 h after surgery,cortisol concentrations were significantly lower（P 〈 0.05）.Compared with the preoperative,postoperative 1,4,12 h MMSE score of both groups were significantly decreased（P 〈 0.05）,both recovered to certain degree at postoperative 24 h.Conclusion Etomidate single induction anesthesia causes transient cognitive decline in the elderly patients,which gradually recovers after 48 h,and is suitable for the elderly patients.