麻醉维持期不同丙泊酚用量对老年OPCABG患者术后认知功能及S100β蛋白的影响

Effects of Varying Maintenance Dosages of Propofol Anesthesia on the Cognitive Function and S100β Protein in Elderly Patients with Off-Pump Coronary Artery Bypass Grafting

【目的】探讨麻醉维持期不同丙泊酚用量对老年非体外循环冠脉搭桥术（0PcABG）患者术后认知功能及S10013蛋白的影响。【方法】选取本院行OPCABG治疗的不稳定性心绞痛患者120例作为研究对象，根据麻醉维持期不同丙泊酚用量分为A组[80μg／（kg·min）]、B组[100μg／（kg·min）]和C组[120μg／（kg·min）]。比较三组患者术后认知功能障碍（POCD）发生率；三组患者麻醉诱导前（T0）、麻醉诱导完成行时（T1）、气管插管后（T2）、术中切皮时（T3）、手术进行1h（T4）、手术进行2h（T5）、手术结束时（T6）血流动力学及麻醉深度指数（NTI）；三组患者麻醉诱导前（Ta）、手术进行2h（Tb）、手术结束时（Tc）、术后6h（Td）、术后24h（Te）血清S100β蛋白水平。【结果】三组患者手术时间、麻醉时间比较差异无显著性（P〉0．05）；B组（12．5％）、C组（7．5％）POCD发生率均低于A组（32．5％）（P〈0．05）；C组NTI均低于A组和B组（P〈0．05），C组T6时刻平均动脉压（MAP）、心率（HR）均低于A组和B组（P〈0．05）；B组、C组Tb、Tc、Td、Te时刻血清S100β蛋白水平均低于A组（P〈0．05）。【结论】丙泊酚靶控榆注（TCI）泵注100μg／（kg·min）进行麻醉维持既可以达到较满意的麻醉深度，又减轻了对血流动力学影响，并降低了POCD发生率及血清S100β蛋白水平，值得临床重视。

[Objective]To investigate the effects of varying maintenance dosages of propofol anesthesia on the cognitive function and S100β protein expression in elderly patients with Off-Pump Coronary Artery Bypass Grafting （OPCABG）. [Methods]In our hospital, 120 cases of unstable angina pectoris patients were given OPCABG treatment and selected as the research subjects. According to the varying maintenance dosages of propofol anesthesia, the 120 patients were divided into the A group [ n =40,80μg/（kg · min）], B group[ n =40,100μg/（kg · min）], and C group [ n =40,120 μg/（kg · min）]. The incidence of cognitive dysfunction （POCD） in the three groups was compared. The hemodynamics and anesthesia depth index （NT1） were observed at many different times among those groups： before induction of anesthesia （T0）, immediate after anesthesia induce complete （T1）, tracheal intubation （T2）, intraoperative incision during operation （T3）, 1h （T4） and 2h （T5） during operation, and operation end （T6）. Serum S100 beta protein levels were also compared at different times： before the induction of anesthesia （Ta）, 2h into the operation （Tb）, at the end of operation （Tc）, two hours after the operation （Td）, and 24h after the operation （Te）.[Results]The operation times and anesthesia times among the three groups had no significant differences （ P 〉0.05）. The incidence of POCD in the three groups were as follows： B group （12.5 % ）, C group （7.5%）, A group （32.5%）. The incidence of POCD in the A group was much higher than in either the B or C group with sta- tistically significant difference （ P 〈0.05）. The C group＇s NTI was lower than the A group＇s and B group＇s （ P 〈0.05）. The MAP and HR of the C group at T6 were lower than in either the A group or the B group （ P 〈0.05）. At Tb, Tc, Td, and Te, the serum S100 protein levels were lower in the B and C groups than in the A group （ P 〈0.05）. [Conclusion]The use of TCI 100 μg/（kg· min）of propofol anesthesia can achieve the most satisfactory depth of anesthesia, lessen the influence on hemodynamics, reduce the incidence of POCD, and lower the serum S100 protein levels-and is worthy of more clinical attention.