七氟烷吸入麻醉后老年患者术后认知功能障碍的影响因素

Influencing factors of postoperative cognitive dysfunction in elderly patients undergoing sevoflurane anesthesia

目的:观察七氟烷吸入麻醉后老年患者术后认知功能障碍(POCD)的影响因素及其与脑脊液Tau蛋白的关系。方法:选择2015年6月至2016年6月于温州市人民医院行等离子前列腺切除术患者总计65例,年龄均≥65岁,ASA分级I^III级,分别于麻醉诱导前、术后1 h抽取5 m L脑脊液,用ELISA试剂盒测定Tau5、p262Tau蛋白浓度。根据是否发生POCD分为非POCD组和POCD组,比较2组患者术后脑脊液中Tau5、p262Tau蛋白浓度,用多因素logistic回归分析POCD发生的相关危险因素。结果:术后共有22例(占39%)患者发生了POCD,非POCD组和POCD组患者一般资料、术中麻醉用药、手术时间等各指标比较差异无统计学意义(P>0.05)。非POCD组术后1 h脑脊液中p262Tau蛋白浓度显著低于POCD组(P<0.05);POCD组术后1 h脑脊液中p262Tau蛋白浓度与术前比较差异有统计学意义(P<0.05)。多因素logistic回归分析表明,脑脊液p262Tau蛋白浓度、年龄、受教育程度、高血压病史是POCD发生的危险因素。结论:七氟烷吸入麻醉后老年患者术后认知功能障碍与脑脊液内Tau蛋白过度磷酸化有关,年龄、受教育程度、高血压病史是POCD发生的危险因素。

Objective： To investigate the effect of sevoflurane anesthesia on postoperative cognitive dysfunction in elderly patients and the relationship with Tau protein in cerebrospinal fluid. Methods： Sixty-five ASA I-III patients aged over 65 years undergoing eletive plasma resection of prostate were enrolled. All patients were received spinal anesthesia at L3-4 interspace and inserted with spinocath catheter. Cerebrospinal fluid and peripheral venous blood were sampled respectively before induction and at 1 h after operation. The expression levels of Tau5 and p262Tau protein were determined by the enzyme-linked immunosorbent assay （ELISA）. Anesthesia was maintained with sevoflurane. Patients were divided into the POCD group and the non-POCD group by the MMSE scores and Z scores which were performed 1 d before and 7 d after operation. The Tau5 and p262Tau protein concentrations of the two groups were taken into comparison. Results： Twenty-two of the elders developed POCD （39%）. There were no significant differences in general conditions and operative indicators between the two groups. The expression levels of Tau5 and p262Tau protein in cerebrospinal fluid had no significant differences between two groups before induction （P〉0.05）. Compared with non-POCD group, the p262Tau protein concentration was significantly increased in POCD group after operation （P〈0.05）. The expression of p262Tau protein was up-regulated in POCD group in 1 h after operation compared to preoperation （P〈0.05）. Conclusion： In incidence of POCD is associated with the increase of Tau protein phosphorylation ser262Tau in cerebrospinal fluid in elderly patients during sevoflurane anestheisa.