不同剂量布托啡诺对急性颅脑外伤手术术后认知功能及Klotho蛋白的影响

Effects of different doses of Butorphanol influence POCD and Klotho protein in patients with acute craniocerebral trauma after operation

目的探讨不同剂量布托啡诺对急性颅脑外伤手术术后认知功能(POCD)及Klotho蛋白的影响。方法前瞻性选取于2016年1月至2017年12月因急性颅脑外伤入南宁市第二人民医院进行开颅手术治疗的患者120例作为研究对象,按照随机数字法随机分为A、B、C三组,每组均为40例。其中A组为低剂量组[布托啡诺起始剂量、维持剂量均为10μg/(kg·h)],B组为中等剂量组[布托啡诺起始剂量、维持剂量均为20μg/(kg·h)],C组为高剂量组[布托啡诺起始剂量、维持剂量均为30μg/(kg·h)]。比较分析三组的术后1 h、术后12 h、术后24 h、术后48 h、术后72 h的简易智能精神状态量表(MMSE)评分,外周血Klotho蛋白水平,POCD的发生率;对MMSE评分,外周血Klotho蛋白水平,POCD的发生率进行相关性分析。结果 B组患者术后12 h、术后24 h、术后48 h MMSE评分,外周血Klotho蛋白水平,POCD的发生率均优于A组和C组,差异具有统计学意义(P<0.05);三组患者外周血Klotho蛋白水平与POCD的发生率呈负相关(r=-0.742,P=0.001);外周血Klotho蛋白水平与MMSE评分呈正相关(r=0.772,P=0.001);MMSE评分与POCD的发生率呈负相关(r=-0.762,P=0.001)。结论中等剂量的布托啡诺用以急性脑损伤患者术后镇痛,其可以有效降低POCD的发生率。同时外周血的Klotho蛋白水平与POCD的发生呈高度相关性,可能成为临床上作为提前干预POCD的有效参考指标之一,但仍需要更大样本量、更严谨的实验研究来证实。

Objective To investigate the effects of different doses of Butorphanol on cognitive function（POCD） and Klotho protein in patients with acute craniocerebral trauma. Methods This was a prospective study,From January 2016 to December 2017,120 patient who had acute craniocerebral injury were divided into A group,B group,C group according to the random number method,40 cases in each group. A group was low dose,B group was medium dose,C group was high-dose. Comparative analysis the MMSE score,the level of Klotho protein in peripheral blood and the incidence of POCD in 1 h,12 h,24 h,48 h. Analyzed the correlation between MMSE score,peripheral blood Klotho protein level and POCD incidence. Results The MMSE score,the level of Klotho protein in peripheral blood and the incidence of POCD in 12 h,24 h,48 h,the B groups were better than those in A group and C group,the difference was statistically significant（P〈0. 05）. The level of Klotho protein in peripheral blood of the three groups was negatively correlated with the incidence of POCD（r =-0. 742,P = 0. 001）,and the level of Klotho protein in peripheral blood was positively correlated with the MMSE score（r = 0. 772,P = 0. 001）,and the MMSE score was negatively correlated with the incidence of POCD（r =-0. 762,P = 0. 001）. Conclusion Moderate dose of Bhuttophanol in postoperative analgesia for patients with acute brain injury can effectively reduce the incidence of POCD. At the same time,the level of Klotho protein in peripheral blood is highly correlated with the occurrence of POCD,which may be one of the effective reference indicators for the early intervention of POCD,but it still needs a larger sample size and more rigorous experimental research to confirm the author＇s view.