血浆谷氨酸与γ-氨基丁酸水平对麻醉后幼儿早期认知功能障碍的相关性研究

Study on the correlation between plasma lutamate and gamma aminobutyric acid levels and early cognitive function after anesthesia with propofol or etomidate

目的观察丙泊酚或依托咪酯麻醉对幼儿腹腔镜下疝修补术后早期认知功能及血浆谷氨酸(Glu)与γ-氨基丁酸(GABA)含量的改变,探讨血浆谷氨酸与γ-氨基丁酸水平变化与丙泊酚或依托咪酯麻醉后幼儿早期认知功能障碍的相关性。方法 100例1~3岁拟行择期腹腔镜下疝修补术患儿,随机分为丙泊酚麻醉组(A组)、依托咪酯麻醉组(B组)各50例;50例同年龄段健康幼儿作对照组(C组)。A、B组麻醉诱导分别给予丙泊酚1~3 mg·kg^(-1)、依托咪酯0.1~0.4 mg·kg^(-1)。比较A、B组内及组间术后认知功能障碍组和术后非认知功能障碍组患儿血浆谷氨酸、γ-氨基丁酸含量的变化。结果 A、B组术后3 d发生术后认知功能障碍的例数分别为10例(20.0%)、9例(18.0%,P>0.05)。与术前比较,A、B组出麻醉恢复室时非术后认知功能障碍组患儿血浆谷氨酸、γ-氨基丁酸含量略有升高,差异均无统计学意义(P>0.05),术后认知功能障碍组患儿血浆谷氨酸、γ-氨基丁酸含量均显著升高(P<0.05)。A、B组幼儿出麻醉恢复室时血浆谷氨酸、γ-氨基丁酸含量升高均,与其术后3 d发生术后认知功能障碍正相关(P<0.05)。结论血浆谷氨酸、γ-氨基丁酸含量可间接反映麻醉后幼儿发生不同程度的脑损伤,可作为幼儿术后早期发生术后认知功能障碍的检测指标。

Objective To observe the effects of propofol or etomidate anesthesia on early cognitive function in infant with laparoscopic hernia repair and its influence on the content changes of glutamate（ GLU） and gamma aminobutyric acid（ GABA） in plasma,and explore the correlation between plasma glutamate and glutamate levels and early cognitive function after anesthesia with propofol or etomidate. Methods One hundred cases of 1-3 years pediatric patients,scheduled for elective laparoscopic hernia neoplasty, were divided into propofol anesthesia group（ group A）,etomidate anesthesia group（ group B）,50 cases in each;50 cases of the same age healthy children as control group（ group C）.A,B groups were given propofol anesthesia induction of 1-3 mg·kg^（-1）,0. 1-0. 4 mg·kg^（-1） etomidate. The changes of GLU,GABA content of patients in the cognitive dysfunction group and non post operative cognitive dysfunction group were compared within A,B groups or between them. Results The number of postoperative cognitive dysfunction inA and B groups were 10（ 20. 0%） and 9 cases（ 18. 0%,P〈0. 05）,respectively. Compared with the preoperative B and A group,there was a slight increase of GLU and GABA in the patients with non post-operative cognitive dysfunction,and the difference had no statistically significant（ P〈0. 05）,but the contents of them had obvious increase in postoperative cognitive dysfunction group（ P〈0. 05）. The elevation of GLU and GABA had a positive correlation with the occurrence of cognitive dysfunction. Conclusion The levels of GLU and GABA in plasma can indirectly reflect the brain injury degrees of infants after anesthesia,which could be used as a detective index for the incidence of cognitive dysfunction in early postoperative infants.