血清S100β蛋白水平与丙泊酚及依托咪酯麻醉后幼儿早期认知功能障碍的相关性研究

发布时间：2018-11-14 17:06

【摘要】：目的目前临床上缺乏术后认知功能障碍(postoperative cognitive dysfunction,POCD)客观的诊断方法。文中通过比较丙泊酚及依托咪酯麻醉对患儿术后早期认知功能及血清S100β蛋白水平的影响,探讨其间相关性。方法收集桂林医学院附属医院2013年7月至2014年11月1~3岁行腹腔镜下疝修补术患儿的病例资料。排除既往有系统疾病、术后发生并发症等任何影响认知功能评估或不能配合完成全程测试的患儿。将最终纳入的100例资料采用单纯随机法分为丙泊酚麻醉组(丙泊酚组)和依托咪酯麻醉组(依托咪酯组)各50例。2组患儿均于术前1 d及术后3 d采用贝莉婴患儿认知量表Ⅲ按月龄进行相应年龄段的认知功能评估,并均按照Z计分法进行POCD诊断。根据患儿是否发生POCD将每组进一步分为POCD和NPOCD 2个亚组。同时丙泊酚组和依托咪酯组患儿分别于术前(T0)、出麻醉恢复室前(T1)抽取髂内静脉血5 m L,酶联免疫吸附法检测血清S100β蛋白浓度;比较2组组内及组间POCD和NPOCD患儿血清S100β蛋白水平的改变。结果1丙泊酚组和依托咪酯组术后3 d分别有10(20.0%)和9(18.0%)名患儿发生POCD,组间POCD发生率比较差异无统计学意义(P0.05);2与T0比较,2组患儿T1时血清S100β蛋白含量均升高,差异有统计学意义(P0.05);与NPOCD患儿比较,2组POCD患儿血清S100β蛋白含量均明显升高,差异有统计学意义(P0.05);组间比较,T1时NPOCD患儿和POCD患儿血清S100β蛋白含量差异均无统计学意义(P0.05);3丙泊酚组与依托咪酯组患儿术毕血清S100β蛋白含量与术后3 d发生POCD相关(r=0.842,P=0.001;r=0.821,P=0.001)。结论丙泊酚或依托咪酯麻醉后可引起1~3岁患儿术后出现不同程度的认知功能下降。患儿麻醉后血清S100β蛋白含量升高与术后早期发生POCD具有正相关性,血清S100β蛋白含量升高能间接反映麻醉后患儿发生不同程度的脑损伤,并可作为患儿术后早期发生POCD的检测指标。丙泊酚及依托咪酯麻醉对患儿术后早期POCD发生率及麻醉后血清S100β蛋白含量变化无明显差异。
[Abstract]:Objective to evaluate the lack of objective methods for the diagnosis of postoperative cognitive dysfunction (postoperative cognitive dysfunction,POCD). By comparing the effects of propofol and etomidate anesthesia on early cognitive function and serum S100 尾 protein level, the correlation between propofol and etomidate was discussed. Methods data of children with laparoscopic herniorrhaphy from July 2013 to November 1, 2014 in affiliated Hospital of Guilin Medical College were collected. Any children whose cognitive function can not be evaluated or who fail to complete the whole test are excluded from previous systemic diseases, postoperative complications and so on. 100 cases were randomly divided into propofol anesthesia group (propofol group) and etomidate anesthesia group (etomidate group). The cognitive function of children with cognitive scale 鈪，

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