丙泊酚对关节置换术病人术后认知功能障碍及早期氧化应激状态的影响

Effects of propofol on postoperative cognitive dysfunction and early postoperative oxidative stress in patients with joint replacement

目的:研究丙泊酚对关节置换术病人术后认知功能障碍(POCD)的影响及其与术后早期氧化应激状态的相关性。方法:选取拟行关节置换术病人50例,随机分为观察组和对照组,各25例。对照组病人术中麻醉维持吸入七氟醚,观察组静脉输注丙泊酚。比较2组病人术后6 h简易智力状态检查量表(MMSE)评分、POCD发生率、血清氧化应激指标[丙二醛(MDA)、超氧化物歧化酶(SOD)、8-羟基脱氧鸟苷(8-OHdG)、白细胞NADPH氧化酶(NOX)活性]水平。结果:观察组病人术后MMSE评分、SOD水平均高于对照组,POCD发生率和血清MDA、8-OHdG、NOX活性均低于对照组(P<0.05~P<0.01)。术后发生POCD病人与非POCD病人麻醉维持药物应用和术后血清SOD、MDA、8-OHdG、NOX活性差异均有统计学意义(P<0.05~P<0.01)。logistic回归分析显示,麻醉维持应用丙泊酚和术后高SOD水平均为关节置换术病人POCD发生的保护因素(P<0.05),术后高水平MDA、8-OHdG、NOX均为POCD发生的危险因素(P<0.05~P<0.01)。结论:麻醉维持应用丙泊酚有助于减少关节置换术病人术后POCD发生。

Objective:To investigate the effect of propofol on postoperative cognitive dysfunction(POCD)in patients with joint replacement and its correlation with early postoperative oxidative stress.Methods:Fifty patients who received joint replacement were selected and divided into an observation group and a control group of 25 patients each.In the control group,sevoflurane was selected for the maintenance of anesthesia during operation,and the observation group was selected by intravenous infusion of propofol.The scores of Mini-Mental State Examination(MMSE),the incidence of POCD,serum oxidative stress[malondialdehyde(MDA)],superoxide dismutase(SOD),8-hydroxydeoxygenation(8-OHdG)and leukocyte NADPH oxidase(NOX)activity were compared 6 h after operation.Results:After operation,the MMSE score and SOD level in the observation group were significantly higher than those in the control group,and the incidence of POCD and the activities of serum MDA,8-OHdG and NOX were significantly lower than those in the control group(P<0.05 to P<0.01).The differences in anesthesia maintenance drug application and postoperative serum SOD,MDA,8-OHdG,and NOX activities were statistically significant between patients who developed POCD postoperatively and those who did not(P<0.05 to P<0.01).Logistic regression analysis showed that propofol and postoperative high serum SOD levels were protective factors for POCD in patients with joint replacement,and postoperative high serum MDA,8-OHdG and NOX were risk factors for POCD(P<0.05 to P<0.01).Conclusions:Propofol application for anesthesia maintenance helps to reduce the incidence of postoperative POCD in patients undergoing joint replacement.