麻醉方法对Klotho蛋白的影响

发布时间：2018-12-27 15:04

【摘要】：目的：本课题旨在探讨麻醉方法对Klotho蛋白含量的变化是否与老年患者POCD的发生存在关系,为我国研究老年患者POCD的发生提供了新的研究方向。方法：选择65岁以上ASAI-II级拟行全身麻醉的老年患者70例,其中男性38例,女性32例。既往无手术史和中枢神经系统疾病史。将上述患者采用抽签法随机分为2组,即全凭静脉麻醉组标为T组,吸入麻醉组标为I组。分别选择对患者在术前1天,术后第1天以及第3天进行精神状态检查量表MMSE的评估。.麻醉诱导：咪达唑仑0.1-0.15mg/kg、芬太尼0.002-0.004mg/kg、依托咪酯0.15-0.3mg/kg、维库溴铵0.1mg/kg。术中麻醉维持：T组采用微量泵给与异丙酚3-6mg·kg-1·h-1、瑞芬太尼0.05-0.20μg·kg-1·min-1、术中维库溴铵间断给药；,I组根据患者体重等指标采用吸入3-5%的异氟醚,且术中同样给与维库溴铵间断给药。手术开始后T组根据患者的当时血压,心率情况及时调整丙泊酚或瑞芬太尼的剂量,加大或减小剂量等；而I组也同样根据患者血压,心率情况调整吸入麻醉药异氟醚的剂量,选择加大或减小吸入量。分别于手术麻醉前设为T1,手术结束麻醉停药后设为T2两个时间点抽取静脉血,并采用ELISA技术对血清中Klotho蛋白的含量进行测量。结果： 1.术后1天POCD的发生率为37.88%,第3天均恢复正常。 2.ELISA技术测量术后Klotho蛋白的含量较术前的含量明显降低,且发生POCD的患者中术后Klotho蛋白的含量下降的更为明显。结论：术后认知功能障碍的发生可能与Klotho基因之间存在着一定的联系,全凭静脉和吸入两种麻醉方法都可以导致患者体内Klotho蛋白的下降,吸入麻醉造成的老年患者体内Klotho蛋白值比全凭静脉麻醉下降的更显著。
[Abstract]:Objective: to explore the relationship between the changes of Klotho protein and the occurrence of POCD in elderly patients, and to provide a new research direction for the study of POCD in elderly patients in China. Methods: seventy elderly patients (38 males and 32 females) with ASAI-II grade over 65 were selected for general anesthesia. There was no history of surgery or central nervous system disease. The patients were randomly divided into two groups: total intravenous anesthesia group as T group and inhalation anesthesia group as group I. Patients were assessed with mental state scale (MMSE) 1 day before operation, 1 day after operation and 3 days after operation. Anesthesia induction: midazolam 0.1-0.15 mg / kg, fentanyl 0.002-0.004 mg / kg, etomidate 0.15-0.3 mg / kg, vecuronium 0.1 mg / kg. Anesthesia maintenance: group T was given propofol 3-6mg kg-1 h-1 by micropump, remifentanil was administered intermittently by vecuronium during operation with remifentanil 0.05-0.20 渭 g kg-1 min-1,. Group I was inhaled 3-5% isoflurane according to the patient's body weight and was also given vecuronium intermittently during the operation. After operation, T group adjusted the dose of propofol or remifentanil in time according to the patient's blood pressure and heart rate, and increased or decreased the dose. Group I also adjusted the dose of inhaled anesthetic isoflurane according to the patient's blood pressure and heart rate. The venous blood was taken at T 1 before operation and T 2 at the end of operation, and the content of Klotho protein in serum was measured by ELISA technique. Results: 1. The incidence of POCD was 37.88 on the first day after operation and returned to normal on the third day. The content of Klotho protein was significantly decreased by 2.ELISA technique, and the content of Klotho protein was significantly decreased in the patients with POCD. Conclusion: there may be some relationship between the occurrence of postoperative cognitive dysfunction and Klotho gene. Both intravenous and inhaled anesthesia can lead to the decrease of Klotho protein in patients. The levels of Klotho protein in elderly patients with inhaled anesthesia were significantly lower than those of intravenous anesthesia alone.
【学位授予单位】：延边大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614

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