不同麻醉药物对老年骨科手术患者术后认知功能的影响及其机制

发布时间：2018-03-20 07:57

本文选题：术后认知功能障碍　切入点：老年患者　出处：《中国医院药学杂志》2017年07期 　论文类型：期刊论文

【摘要】：目的:比较异氟烷、七氟烷两种吸入性麻醉药对老年骨科手术患者术后认知功能障碍(POCD)及血清S-100β蛋白、炎性因子表达水平的影响,分析探讨其与神经炎症的关系。方法:选择择期进行骨科手术的老年患者90例(其中行髋关节置换术患者42例,行骨折内固定术患者48例),随机分为A、B两组,每组45例,全身诱导麻醉后分别以异氟烷、七氟烷维持麻醉。手术麻醉期间记录两组患者的手术时间、麻醉时间和苏醒时间;分别于手术麻醉前(T0)和手术后6 h(T_1),1 d(T_2),3 d(T_3),5 d(T_4)抽取两组患者外周静脉血,并采用MMSE评分法进行神经精神功能测试,计算POCD发生率;ELISA法检测血清中S-100β及炎性因子IL-1β、TNF-α、IL-6的浓度。结果:(1)两组手术时间、麻醉时间无明显差异(P0.05),A组术后苏醒时间明显长于B组(P0.05)。(2)术前两组的MMSE评分、血清指标水平均无显著差异(P0.05);A组术后1 d和3 d时MMSE评分明显低于同组术前及B组对应时间点(P0.05),且术后5 d内POCD发生率明显高于B组(P0.05)。(3)A组术后1 d和3 d时,血清S-100β、IL-1β及IL-6水平均明显高于同组术前及B组对应时间点(P0.05);两组术后6 h,1 d,3 d时TNF-α水平均显著高于术前(P0.05),且A组比B组升高程度更大(P0.05)。结论:吸入性麻醉药异氟烷可引起老年患者POCD以及中枢神经特异蛋白S-100β、炎性因子表达增加,而七氟烷的影响不明显,其机制可能与老年患者中枢神经系统炎症有关。
[Abstract]:Objective: to compare the effects of isoflurane and sevoflurane on the expression of serum S-100 尾 protein and inflammatory factors in elderly patients with cognitive dysfunction after orthopedic surgery. Methods: ninety patients (42 patients with hip arthroplasty and 48 patients with internal fixation of fracture) who underwent orthopedic surgery were randomly divided into two groups: group A (n = 45), group A (n = 45). The anesthesia was maintained by isoflurane and sevoflurane respectively after general induction anesthesia. The peripheral venous blood samples were collected before operation before anesthesia (T0) and 6 hours after operation (1 hour after operation) and 6 hours after operation. The peripheral venous blood was collected from two groups of patients. The neuropsychiatric function was tested by MMSE scoring method. Serum S-100 尾 and inflammatory factor IL-1 尾 TNF- 伪 IL-6 were measured by Elisa. Results there was no significant difference in anesthesia time between the two groups. The postoperative recovery time of group A was significantly longer than that of group B (P 0.05). There was no significant difference in serum index levels. The MMSE score of group A was significantly lower than that of group B at 1 and 3 days after operation, and the incidence of POCD within 5 days after operation was significantly higher than that in group B at 1 and 3 days after operation. The serum levels of S-100 尾 IL-1 尾 and IL-6 were significantly higher than those in the same group before operation and at the corresponding time point in group B, and the levels of TNF- 伪 in both groups were significantly higher than those in the preoperative group at 1 hour or 3 days after operation, and the degree of increase in group A was higher than that in group B. conclusion: the inhaled anesthetic isoflurane is more serious than that in group B. It can induce POCD and S-100 尾, and increase the expression of inflammatory factors in elderly patients. The effect of sevoflurane is not obvious and its mechanism may be related to central nervous system inflammation in elderly patients.
【作者单位】：西南医科大学研究生部;四川省德阳市第五医院麻醉科;德阳市人民医院麻醉科;西南医科大学附属医院麻醉科;
【分类号】：R614

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