依托咪酯和丙泊酚对老年患者腹腔镜胆囊切除术后认知功能障碍的影响

Influence of Propofol and Etomidate on Cognitive Dysfunction of Elderly Patients after Laparoscopic Cholecystectomy

目的：探讨在全身麻醉中,依托咪酯和丙泊酚对老年患者腹腔镜胆囊切除术（LC）后早期认知功能障碍（POCD）的影响及血清S100β蛋白对早期POCD发生的意义。方法：选择年龄〉65岁、在喉罩通气全身麻醉下行LC的患者60例,采用随机数字表法分为依托咪酯组（E组）和丙泊酚组（P组）,每组30例。麻醉诱导为静脉注射依托咪酯0.3mg/kg（E组）或丙泊酚1.5mg/kg（P组）,另加舒芬太尼0.4μg/kg、维库溴铵0.12mg/kg。麻醉维持为静脉泵入瑞芬太尼0.15μg/（kg·min）,持续靶控输注依托咪酯（靶浓度1.0~1.5μg/ml）（E组）或丙泊酚（靶浓度3.0~4.0μg/ml）（P组）,通过调整依托咪酯或丙泊酚靶浓度,维持脑电双频指数（BIS）为40~50。于术前1 h（T0）、术后2 h（T1）、术后24 h（T2）及术后48 h（T3）分别抽取患者动脉血,检测S100β蛋白含量并记录简易智力状态检查（MMSE）评分,同时观察并记录两组患者苏醒时间、拔除喉罩时间、麻黄碱用量及术中知晓情况。结果：两组患者各时点MMSE评分组间比较差异无统计学意义（P〉0.05）;两组患者T1和T2时的MMSE评分均明显低于T0时,差异有统计学意义（P〈0.05）。两组患者各时点S100β蛋白含量组间比较差异无统计学意义（P〉0.05）;两组患者T1和T2时的S100β蛋白含量均明显高于T0时,差异有统计学意义（P〈0.05）。两组患者苏醒时间和拔除喉罩时间均较短,差异无统计学意义（P〉0.05）;P组患者麻黄碱用量明显多于E组,差异有统计学意义（P〈0.05）。两组患者术后随访均无术中知晓发生。结论：依托咪酯和丙泊酚全身麻醉均可安全地用于老年患者LC,均能引起不同程度的短暂POCD。血清S100β蛋白含量与早期POCD的发生有一定相关性。

OBJECTIVE： To discuss the effect of etomidate and propofol on early postoperative cognitive dysfunction（POCD）of elderly patients after laparoscopic cholecystectomy（LC）and significance of serum protein S100β to the occurrence of early POCD in total intravenous anesthesia. METHODS：60 patients aged 65 years old above undergoing LC in total LMA intravenous anesthesia were selected and randomly divided into etomidate group（group E）and propofol group（group P）,with 30 cases in each group. Anesthesia was induced by etomidate 0.3 mg/kg（group E）or propofol 1.5 mg/kg（group P）,and additionally induced by sufentanil 0.4 μg/kg and vecuronium 0.12 mg/kg. Anesthesia was maintained with intravenous pump of remifentanil 0.15 μg/（kg·min）,continuous target controlled infusion of etomidate（target concentration 1.0-1.5 μg/ml）（group E）or propofol（target concentration 3.0-4.0 μg/ml）（group P）;the dual brain index（BIS）values were maintained between 40 and 50 throμgh adjusting target concentration of etomidate or propofol. The blood samples were collected 1 h before operation（T0）,2 h（T1）,24 h（T2）,48 h（T3）after operation,and the content of S100β protein was detected and mini-mental state examination（MMSE）score were recorded. Meanwhile,recovery time,laryngeal mask removal time,intraoperative dosage and the occurrence of intraoperative awareness were observed and recorded in 2 groups. RESULTS：There was no statistically significant difference in MMSE score between2 groups at different time points（P〉0.05）;MMSE score of 2 groups at T1 and T2was significantly lower than at T0,with statistical significance（P〈0.05）. There was no statistically significant difference in the content of S100β protein between 2 groups at different time points（P〉0.05）;The contents of S100β protein in 2 groups at T1 and T2were significantly higher than at T0,with statistical significance（P〈0.05）. The recovery time and laryngeal mask removal time were both short in 2 groups,with statistical significance（P〉0.05）. The amount of ephedrine in group P was significantly higher than in group E,with statistical significance（P〈0.05）. No intraoperative awareness occurred in 2 groups thro μ gh postoperative follow-up. CONCLUSIONS：Etomidate and propofol total intravenous anesthesia can be safely used in elderly patients with LC,and they can cause short-term POCD at different degrees. The amount of S100β protein has some relevance with the occurrence of early POCD.