丙泊酚与七氟醚对老年患者术后早期认知功能障碍的影响

Effects of propofol and sevoflurane on early postoperative cognitive dysfunction in elderly patients

目的探讨丙泊酚全凭静脉麻醉和七氟醚吸入麻醉对老年患者术后早期认知功能障碍的影响。方法选取择期行胃癌或肠癌根治术的老年患者50例,随机分为丙泊酚全凭静脉麻醉组(丙泊酚组)和七氟醚吸入麻醉组(七氟醚组)。于麻醉诱导前(T_0)、术后1 h(T_1)、术后第1天早晨(T_2)及术后第3天早晨(T_3)抽取中心静脉血,应用酶联免疫吸附测定(ELISA)检测血清中白介素(IL)-1β、IL-6、IL-10、肿瘤坏死因子-α(TNF-α)和S100β蛋白水平。所有患者于术前1 d和术后第3天进行简明精神症状量表(MMSE)评分,MMSE得分降低≥2分即认定为认知功能障碍。结果与T_0时间点比较,除外七氟醚组T_3时间点的IL-1β,两组各时间点的IL-1β、IL-6、IL-10及TNF-α水平均有所升高,且差异具有统计学意义(P<0.05)。丙泊酚组在T_1和T_2时间点时IL-6水平及T_1时间点的TNF-α水平低于同时间点七氟醚组,且差异具有统计学意义(P<0.05)。与T_0时间点比较,丙泊酚组各时间点及七氟醚组T_2和T_3时间点的S100β水平均有所升高,且差异均具有统计学意义(P<0.05)。两组术后认知功能障碍(POCD)发生率差异无统计学意义(P>0.05),MMSE评分的子项目中,丙泊酚组术后的回忆能力评分高于七氟醚组,且差异具有统计学意义(P<0.05)。结论给予老年患者丙泊酚全凭静脉麻醉更有利于减少早期POCD的发生,其在改善回忆能力方面也较七氟醚吸入麻醉更有优势。

Objective To observe the effect of propofol and sevoflurane on early postoperative cognitive dysfunction(POCD) in elderly patients. Methods Fifty elderly patients, who scheduled for gastric or intestinal cancer radical operation with general anesthesia were equally divided into propofol group and sevoflurane group. The central venous blood at before anesthesia induction(T_0), 1 h after operation(T_1), the first day morning after operation(T_2), and the third day morningafter operation(T_3)were collected, then the serum concentration of interleukin(IL)-1β, IL-6, IL-10, tumor necrosis factor-α(TNF-α) and S100β were measured using enzyme linked immunosorbent assay(ELISA). The cognition was evaluated by mini-mental state examination(MMSE)one day before operation and at the third day after operation. Results Compared with T_0 time point, except the level of IL-1β at T3 time point in sevoflurane group, the levels of IL-1β, IL-6, IL-10 and TNF-α at T_1, T_2 and T_3 time points were increased, and the differences were significant(P<0.05). The levels of IL-6 at T1 and T2 time points and TNF-α at T_1 time point in propofol group were lower than those in sevoflurane group, the differences were significant(P<0.05). Compared with T_0 time point, the S100β increased at all time points in propofol group and at T_2 and T_3 time points in sevoflurane group, the differences were significant(P<0.05). The incidence rates of POCD in two groups were no significant difference(P>0.05). Off all the sub-items of MMSE, the postoperative score of recall ability in propofol group was higher than that in sevoflurane group(P<0.05). Conclusion Compared with sevoflurane, propofol total intravenous anesthesia has less incidence rate of early POCD, and better recall ability.