不同麻醉维持方法对老年患者早期术后认知功能障碍的影响

Comparative Analysis of Total Intravenous Anesthesia and combined Anesthesia on Early POCD in Elderly Patients

目的:观察全凭静脉麻醉和静吸复合麻醉两种不同麻醉维持方法对老年患者早期术后认知功能障碍(POCD)的影响。方法:选择全麻行腰椎手术的老年患者100例,随机分A组(50例)和B组(50例),A组采用全凭静脉麻醉,B组采用静吸复合麻醉。记录患者于入室后(TI)、麻醉诱导后(T2)、插管后(T3)、切皮开始(T4)、手术结束(T5)、拔管后(T6)的SBP/DBP、HR和SctO_2;检测患者于麻醉诱导前(X1)、拔管后(X2)、术后第1d(X3)、术后第3d(X4)、术后第7d(X5)静脉血中IL-1β、IL-6、HMGB1、S100P和TNF-α的浓度。记录患者术前及术后早期的神经心理学测试结果。结果:T6时,B组SBP较A组高(P<0.05);T4时,B组SctO_2较A组高(P<0.05)。X1~5时,B组IL-1β均较A组低(P<0.05);X2~4时,B组IL-6较A组低(P<0.05);X2~5时,B组HMGB1较A组低(P<0.05)。与X1时比较,A组X2~4时HMGB1均升高,B组X2~4时HMGB1均降低(P<0.05);与X1时比较,A组X3时IL-6升高,B组X3时IL-6下降(P<0.05)。A组术后第3 d发生POCD10例,B组3例(P<0.05);A组术后第7 d发生POCD8例,B组5例(P>0.05)。结论:静吸复合麻醉和全凭静脉麻醉均可引起老年患者发生早期POCD,在术后第3天时,静吸复合麻醉较全凭静脉麻醉能较少POCD的发生,而在术后第7天时,二者间无明显差异。

Objective： This study was designed to observe the cognitive and clinical outcomes of total intravenous anesthesia and combined anesthesia on the early POCD in the elderly patients. Methods： One hundred elderly patients were randomly assigned to either group A（50 cases） or group B （50 cases）. The maintenance of anesthesia in group A was total intravenous anesthesia and combined intra- venous inhalation anesthesia was in group B. The SBP/DBP, HR and SctO2 were recorded at following time points： before operation （T1）, immediately after induction of anesthesia （T2）, immediately after intubation （T3）, the begining of operation （T4）, the end of operation （T5）, immediately after extubation （T6）, Venous blood were collected at following time points which were before anesthetic induction （X1）, after extubation （X2）, the first day after operation （X3）, the third day after operation （X4） and the seventh day after operation （X5）, to test the concentration of IL-113, IL-6, HMGB 1, S 100P and TNF-α. Neuropsychological tests were performed before, and after surgery. Results： Compared with the group A, The SBP of group B was higher at T6 （P〈0.05）, the SctO2 of group B was higher at T4（P〈0.05 ）. The levels of IL-113in the group B at X1 ~5 were lower than group A （P〈0.05）. The levels oflL-6 in the group B at X2~4 were lower than group A（P〈0.05）. The levels of HMGB1 in the group B at X2~5 were lower than group A （P〈0.05）. The level oflL-6 in group A at X3 was significantly elevated than that at X1 （P〈0.05）but the level oflL-6 in group B at X3 significantly declined than that at X2（P〈0. 05 ）. The levels of HMGB1 in group A at X2~4 were significantly elevated than those at X1 （P〈0.05）, but the level of HMGB1 in group B at X2~4 were significantly decreased than those at X1 （P〈0.05）. On the third day after operation, there were 10 patients diagnosed as early POCD in group A（20%） and there were 3 patients diagnosed as early POCD in group B（6%）, P〈0.05. On the seventh day after oper- ation, there were 8 patients diagnosed as POCD in group A（16%） and 5 patients developed POCD in group B（10%）, P〉O.05. Conelusios： Both total intravenous anesthesia and combined anesthesia can lead to early POCD in elderly patients. On the third day after operation, compared to total intravenous anesthesia, combined anesthesia can reduce the occurrence of POCD, but on the seventh days after surgery, there is no significant difference in incidence rate between them.