异氟醚或七氟醚复合瑞芬太尼麻醉对腹部手术老年病人血β淀粉样蛋白的影响

Effects of isoflurane or sevoflurane combined with remifentanil anesthesia on blood amyloid beta protein in elderly patients undergoing abdominal surgery

目的 比较异氟醚或七氟醚复合瑞芬太尼麻醉对腹部手术老年病人血β淀粉样蛋白的影响.方法 择期全身麻醉下行腹部手术病人200例,性别不限,年龄65 ～ 75岁,体重51～76 kg,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将其分为2组（n=100）：异氟醚复合瑞芬太尼麻醉组（IR组）和七氟醚复合瑞芬太尼麻醉组（SR组）;同期健康老年人50名作为对照组（C组）.麻醉诱导后气管插管,机械通气,麻醉维持采用静吸复合麻醉：异氟醚和七氟醚呼气末浓度分别为1.68％和1.71％,TCI瑞芬太尼,血浆靶浓度2～6 ng/ml.分别于术前1d、术后3d进行简易智能精神状态检查量表评分,记录术后认知功能障碍发生情况,同时采集静脉血样,采用酶联免疫吸附法测定血清β淀粉样蛋白40（Aβ40）和β淀粉样蛋白42（Aβ42）的浓度.结果 C组、IR组和SR组术后认知功能障碍的发生率分别为5％、56％和22％,3组间比较差异有统计学意义（P＜0.05）.3组术后血清Aβ42和Aβ40的浓度比较差异无统计学意义（P＞0.05）.结论 七氟醚或异氟醚复合瑞芬太尼麻醉导致腹部手术老年病人术后认知功能障碍的机制与血Aβ40和Aβ42水平无关.

Objective To compare the effects 0f isoflurane or sevoflurane in combination with remifentanil anesthesia on blood amyloid beta protein （Aβ） in the elderly patients undergoing abdominal surgery. Methods Two hundred patients of both sexes, aged 65-75 yr, weighing 51-76 kg, of ASA physical status Ⅰ or Ⅱ , scheduled for elective abdominal surgery under general anesthesia, were randomly divided into 2 groups （ n = 100 each） using a random number table： isoflurane combined with remifentanil anesthesia group （1R group ） and sevoflurane combined with remifentanil anesthesia group （SR group）. Fifty healthy elderly subjects served as control group （group C ）. After anesthesia was induced with iv penehyclidine, sufentanil, propofol and vecuronium, the patients were endotracheally intubated and mechanically ventilated. In group IR, anesthesia was maintained with inhalation of isoflurane （end-tidal concentration 1.68% , in IR group） or sevoflurane （end-tidal concentration 1.71% , in SR group）, and target-controlled infusion of remifentanil （target plasma concentration 2- 6 ng/ml）. At 1 day before surgery and 3 days after surgery, the patients＇ cognitive function was assessed using Mini-Mental State Examination （MMSE）, the development of postoperative cognitive dysfunction （POCD） was recorded, and blood samples were taken for determination of serum Aβ40 and Aβ42 concentrations. Results The incidence of POCD was 5% （in C group）, 56% （in IR group） or 22% （in SR group）, and there was no significant difference among the three groups. There Were no significant differences in the serum A^342 and A^40 concentrations after surgery among the three groups. Conclusion The mechanism by which sevoflurane or isoflurane in combination with remifentanil anesthesia results in POCD is not related to the levels of blood Aβ40 or Aβ42 in the elderly patients undergoing abdominal surgery.