不同浓度七氟烷和丙泊酚麻醉对老年患者S100β蛋白及术后认知功能的影响

Effect of different concentrations of sevoflurane and propofol anesthesia on S100β protein and postoperative cognitive function in elderly patients

目的探讨不同浓度七氟烷和丙泊酚麻醉对老年患者S100β蛋白及术后认知功能的影响。方法选择ASAⅠ-Ⅱ级拟在腹腔镜下行胃肠手术的老年患者90例,随机分为低浓度组七氟烷(S1组)、高浓度七氟烷组(S2组)和丙泊酚组(P组),每组30例。分别接受丙泊酚和不同浓度的七氟烷麻醉,分别于术前1d(T1)、术后6h(T2)、24h(T3)、72h(T4)对患者进行简易智能精神状态评分(MMSE),并于麻醉前10min(Ta)、术毕10min(Tb)及术后24h(Tc)取颈内静脉球部血测定血清S100β蛋白浓度。结果 MMSE值的变化:与T1比较,3组MMSE值在T2时点均明显降低(P<0.05),P组与S2组在T3时点均明显降低(P<0.05),S1组MMSE值在T3、T4时点无明显变化(P>0.05);与P组同时点比较:T2、T3时点S1组MMSE值比P组高(P<0.05),S2组MMSE值比P组低P<0.05)。血清S100β蛋白含量的变化:与Ta比较,P组与S2组血清S100β蛋白含量在Tb、Tc时点均显著升高(P<0.05),S1组在Tb时点显著升高(P<0.05);与P组同时点比较,S2组血清S100β蛋白含量于Tb时点显著高于P组(P<0.05),S1组血清S100β蛋白含量于Tc时点显著低于P组(P<0.05)。结论丙泊酚和七氟烷麻醉均可引起老年患者术后短期内认知功能下降,但高浓度七氟烷麻醉比丙泊酚麻醉对认知功能的影响程度大,而低浓度七氟烷麻醉比丙泊酚麻醉对认知功能的影响程度小,且术后恢复认知功能更早。

Objective To Investigate the effects of different concentrations of sevoflurane and propofol anesthesia on S100βprotein and postoperative cognitive function in elderly patients. Methods Ninety elderly patients （American Society of Anesthesi-ologists physical statue Ⅰ and Ⅱ） scheduled for laparoscopic gastrointestinal surgery were enrolled in this study. The patients were randomly assigned to three groups：low concentrations of sevoflurane（group S1）,high concentration of sevoflurane group （group S2） and propofol group （group P）,30 patients in each group. All groups received different concentrations of propofol and sevoflu-rane anesthesia,simple mental state score （MMSE） were recorded 1d （T1）,after 6h （T2）,24h （T3）,72h （T4） before operation for pa-tients,And the internal jugular vein bulb blood levels of S100β protein were measured 10min （Ta）,surgery 10min （Tb） and after 24h （Tc） before anesthesia. Results Changes of MMSE：Compared with T1,the MMSE were significantly lower at T2 （P〈0.05） in all groups,group P and group S2 were significantly lower （P〈0.05） in T3 point,MMSE values at T3,T4 were no significant change （P〉0. 05） in group S1;At the same points as compared with group P：MMSE were higher （P〈0.05） at T2,T3 in group S1,were lower in group S2 （P〈0.05）. Changes of serum S100βprotein level：comparison with Ta,the level of serum S100βwere significantly higher at Tb,Tc in group P and S2 （P〈0.05）,group S1 were significantly higher in Tb point （P〈0.05）;the same point compared with the group P,at Tb point,serum S100βprotein level in group S2 was significantly higher （P〈0.05）,at Tc point,the S100βprotein levels serum were significantly lower in S1 than P group （P〈0.05）. Conclusion Although propofol and sevoflurane anesthesia both cause short-term postoperative cognitive decline in elderly patients,high concentrations of sevoflurane anesthesia lead a greater impact on cognitive function than propofol,while low concentrations of sevoflurane have less impact,and recovery of cognitive function were earlier.