丙泊酚／七氟醚不同配伍麻醉对轻度认知功能障碍老年患者术后认知功能的影响

Effects of different ratios of medicine dosage for propofol and sevoflurane on postoperative cognitivefunction in elderly patients with mild cognitive impairment

目的评价丙泊酚/七氟醚不同配伍麻醉对轻度认知功能障碍老年患者术后认知功能的影响。 方法择期全身麻醉行下肢骨折手术患者96例，性别不限，年龄65～75岁，体重60～80 kg，ASA分级Ⅰ或Ⅱ级，术前并存轻度认知功能障碍。采用随机数字表法将患者分为4组（n＝24）：丙泊酚组（P组）、七氟醚组（S组）和丙泊酚/七氟醚不同配伍组（PS1组和PS2组）。于术前1 d（T0）和术后7 d（T1）时采用MMSE评分和MoCA评分评估患者认知功能。于上述时点采集静脉血样，采用ELISA法测定血浆载脂蛋白J（ApoJ）和可溶性白细胞分化抗原14（sCD14）的浓度。 结果与S组比较，P组、PS1组和PS2组T1时MMSE评分和MoCA评分升高，血浆ApoJ和sCD14浓度降低，术后认知功能障碍发生率降低 （P〈0.05）；与PS1组比较，P组和PS2组T1时MMSE评分和MoCA评分降低，血浆ApoJ和sCD14浓度升高，术后认知功能障碍发生率升高（P〈0.05）；与T0时比较，T1时S组、P组、PS2组MMSE评分和MoCA评分降低，血浆ApoJ和sCD14浓度升高（P〈0.05），PS1组上述各指标差异无统计学意义（P〉0.05）。 结论靶控输注丙泊酚血浆靶浓度1.2 μg/ml复合吸入0.7%～1.2%七氟醚麻醉维持不加重轻度认知功能障碍老年患者术后认知功能障碍。

Objective To evaluate the effects of different ratios of medicine dosage for propofol and sevoflurane on postoperative cognitive function in elderly patients with mild cognitive impairment. Methods Ninety-six patients of both sexes, aged 65-75 yr, weighing 60-80 kg, of American Society of Anesthe- siologists physical status I or I1 , scheduled for elective lower limb fracture operation under general anes- thesia, with mild cognitive impairment before surgery, were assigned into 4 groups （n = 24 each） using a random number table： propofol group （group P） , sevoflurane group （group S） and different ratios of med- icine dosage for propofol and sevoflurane groups （group PSI and group PS2）. Montreal Cognitive Assess- ment （MoCA） and Mini-Mental State Examination （MMSE） were used to evaluate the cognitive function of patients at 1 day before operation （To） and 7 days after operation （T1 ）. Venous blood samples were col- lected at TO and T for determination of the concentrations of plasma apolipoprotein J （ApoJ） and soluble CD14 （sCD14） by enzyme-linked immunosorbent assay. Results Compared with group S, MMSE and MoCA scores were significantly increased and plasma concentrations of ApoJ and sCD14 were decreased at Tl , and the incidence of postoperative cognitive dysfunction was decreased in P, PS1 and PS2 groups （P〈0.05）. Compared with group PS1, MMSE and MoCA scores were significantly decreased and the plasma concentrations of ApoJ and sCD14 were increased at T~ , and the incidence of postoperative cognitive dys- function was increased in P and PS2 groups （P〈0.05）. MMSE and MoCA scores were significantly lower and plasma concentrations of ApoJ and sCD14 were higher at TL than at To in S, P and PS2 groups （P〈 0.05） , and there was no significant difference in the parameters mentioned above between T and To in group PS1 （P〉0.05）. Conclusion Combination of propofol 1.2 g/ml given by target-controlled infusion and 0.7- 1.2% sevoflurane inhalation for maintenance of anesthesia does not aggravate the postoperative cognitive dysfunction in elderly patients with mild cognitive impairment.