不同麻醉方法对老年患者术后认知功能的影响机制

The effects and action mechanism of different anesthesia methods on postoperative cognitive function of elderly patients

目的探讨全凭静脉麻醉法以及静吸复合麻醉法对老年患者术后认知功能的影响及其机制。方法选取择期行腹部手术的老年患者60例,根据患者使用的麻醉方式,将60例患者随进分为A组和B组,每组30例。A组受试者行全凭静脉麻醉,B组受试者行静吸复合麻醉。根据麻醉深度将A、B组各分为3个亚组。测定并比较不同全麻方法以及不同麻醉深度情况下老年患者不同时间点的简易精神状态量表(MMSE)、画钟试验(CDT)评分以及术后认知功能障碍(POCD)的发生情况;此外,测定两种全麻方法中发生以及未发生POCD患者不同时间点的r SO2值和血浆β-淀粉样蛋白水平。结果 2组患者术后1 d和3 d的MMSE评分较术前发生了明显的降低(P<0.05);术后3 d和5 d的MMSE评分明显高于术后1 d(P<0.05);2组患者术后1 d的CDT评分较术前发生明显的降低(P<0.05),并于术后3 d和5 d时显著升高(P<0.05);随着术后时间的增加,2组患者中发生认知功能障碍的人数明显降低(P<0.05);术毕24 h A、B 2组中POCD患者r SO2%max以及血浆β-淀粉样蛋白水平显著高于非POCD患者(P<0.05)。结论两种麻醉方法均会对老年患者术后认知功能产生影响,其发生机制可能与r SO2%max以及血浆β-淀粉样蛋白水平升高相关。

Objective To observe and compare the effects and action mechanism of total intravenous anesthesia（ TIVA） and combined intravenous and inhalation anesthesia（ CIIA） on postoperative cognitive function of elderly patients.Methods Sixty elderly patients who underwent elective abdominal surgery were enrolled in the study. According to different anesthesia ways,the 60 patients were randomly divided into group A and group B,with 30 patients in each group. The patients in group A received TIVA,however,the patients in group B received CIIA,moreover according to the depth of anesthesia,the group A and group B were redivided into three subgroups,respectively. The mini-mental state examination（ MMSE）,clock drawing test（ CDT） scores and the incidence rate of postoperative cognitive dysfunction（ POCD） by different anesthesia ways,in different anesthesia depth and in different time points were observed and compared among groups. Moreover the r SO2 value and plasma beta-amyloid levels in different time points were detected and compared among groups. Results The MMSE scores on 1 d and 3 d after operation were significantly decreased in both groups,as compared with those before operation（ P〈0. 05）,and the MMSE scores on 3 d and 5 d after operation were significantly higher than those on 1 d after operation（ P〈0. 05）. The CDT scores on 1 d after operation were significantly decreased in both groups,as compared with those before operation（ P〈0. 05）,moreover,which were significantly increased on 1 d and 3 d after operation（ P〈0. 05）. With the time going on after operation,the incidence rates of cognitive dysfunction were significantly decreased in both groups（ P〈0. 05）. Besides the levels of r SO2% max and plasma beta-amyloid on 24 h after operation in patients with POCD in group A and group B were significantly higher than those of patients without POCD in both groups（ P〈0. 05）. Conclusion Both anesthesia methods have effects on postoperative cognitive function of elderly patients,and its action mechanism may be correlated to the increase of r SO2% max and plasma beta-amyloid levels.