国际麻醉学与复苏杂志
國際痳醉學與複囌雜誌
국제마취학여복소잡지
INTERNATIONAL JOURNAL OF ANESTHESIOLOGY AND RESUSCITATION
2013年
4期
311-315
,共5页
七氟烷%丙泊酚%同型半胱氨酸%术后认知功能障碍
七氟烷%丙泊酚%同型半胱氨痠%術後認知功能障礙
칠불완%병박분%동형반광안산%술후인지공능장애
Sevoflurane%Propofol%Homocysteine%Postoperation cognitive dysfunction
目的 观察七氟烷或丙泊酚麻醉对老年患者术后认知功能及血清同型半胱氨酸(homocysteine,Hcy)的影响,为临床合理选择麻醉药物和麻醉方法提供参考. 方法 选择美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级行胃大部切除手术的老年患者40例,按随机数字表法分为七氟烷组(A组)和丙泊酚组(B组),每组20例.于术前(T1)、术中2 h(T2)、术后24 h(T3)、术后72 h(T4)抽取外周静脉血,酶联免疫吸附法(enzyme-linked immunosorbent assay,ELISA)测定同型半胱氨酸浓度.于术前1d(S1)、术后6 h(S2)、术后24 h(S3)、术后72 h(S4)应用简易智力状态检查表(MMSE),评估认知功能. 结果 A组和B组在S2时点MMSE评分[(26.2±0.6)和(27.1±0.8)]与术前基础值[(29.5±0.5),(29.4±0.6)]比较均有明显下降(P＜0.05),且A组较B组低.A组和B组术前血清Hcy测定值[(5.8±1.4)μmol/L和(5.9±1.6) tLmol/L]基本相同.A组T2血清Hcy测定值[(6.7±1.5) μmol/L]明显比术前高(P＜0.05),T3、T4时点血清Hcy测定值已回落到术前基础值水平(P＞0.05).B组T2、T3和T4时点血清Hcy测定值虽有升高,与基础值比较差异无统计学意义(P＞0.05). 结论 丙泊酚与七氟烷均能引起老年患者短暂术后认知功能改变,持续吸入1.3最低肺泡有效浓度(minimum alveolar concentration,MAC)七氟醚3.5 h对老年患者术后认知功能障碍的影响比用3μg·kg-1·h-1～5 μg· kg-1·h-1的速率泵注丙白酚3.5 h的影响大.其机制之一可能与血清Hcy的浓度增加有关.
目的 觀察七氟烷或丙泊酚痳醉對老年患者術後認知功能及血清同型半胱氨痠(homocysteine,Hcy)的影響,為臨床閤理選擇痳醉藥物和痳醉方法提供參攷. 方法 選擇美國痳醉醫師協會(ASA)分級Ⅰ～Ⅱ級行胃大部切除手術的老年患者40例,按隨機數字錶法分為七氟烷組(A組)和丙泊酚組(B組),每組20例.于術前(T1)、術中2 h(T2)、術後24 h(T3)、術後72 h(T4)抽取外週靜脈血,酶聯免疫吸附法(enzyme-linked immunosorbent assay,ELISA)測定同型半胱氨痠濃度.于術前1d(S1)、術後6 h(S2)、術後24 h(S3)、術後72 h(S4)應用簡易智力狀態檢查錶(MMSE),評估認知功能. 結果 A組和B組在S2時點MMSE評分[(26.2±0.6)和(27.1±0.8)]與術前基礎值[(29.5±0.5),(29.4±0.6)]比較均有明顯下降(P＜0.05),且A組較B組低.A組和B組術前血清Hcy測定值[(5.8±1.4)μmol/L和(5.9±1.6) tLmol/L]基本相同.A組T2血清Hcy測定值[(6.7±1.5) μmol/L]明顯比術前高(P＜0.05),T3、T4時點血清Hcy測定值已迴落到術前基礎值水平(P＞0.05).B組T2、T3和T4時點血清Hcy測定值雖有升高,與基礎值比較差異無統計學意義(P＞0.05). 結論 丙泊酚與七氟烷均能引起老年患者短暫術後認知功能改變,持續吸入1.3最低肺泡有效濃度(minimum alveolar concentration,MAC)七氟醚3.5 h對老年患者術後認知功能障礙的影響比用3μg·kg-1·h-1～5 μg· kg-1·h-1的速率泵註丙白酚3.5 h的影響大.其機製之一可能與血清Hcy的濃度增加有關.
목적 관찰칠불완혹병박분마취대노년환자술후인지공능급혈청동형반광안산(homocysteine,Hcy)적영향,위림상합리선택마취약물화마취방법제공삼고. 방법 선택미국마취의사협회(ASA)분급Ⅰ～Ⅱ급행위대부절제수술적노년환자40례,안수궤수자표법분위칠불완조(A조)화병박분조(B조),매조20례.우술전(T1)、술중2 h(T2)、술후24 h(T3)、술후72 h(T4)추취외주정맥혈,매련면역흡부법(enzyme-linked immunosorbent assay,ELISA)측정동형반광안산농도.우술전1d(S1)、술후6 h(S2)、술후24 h(S3)、술후72 h(S4)응용간역지력상태검사표(MMSE),평고인지공능. 결과 A조화B조재S2시점MMSE평분[(26.2±0.6)화(27.1±0.8)]여술전기출치[(29.5±0.5),(29.4±0.6)]비교균유명현하강(P＜0.05),차A조교B조저.A조화B조술전혈청Hcy측정치[(5.8±1.4)μmol/L화(5.9±1.6) tLmol/L]기본상동.A조T2혈청Hcy측정치[(6.7±1.5) μmol/L]명현비술전고(P＜0.05),T3、T4시점혈청Hcy측정치이회락도술전기출치수평(P＞0.05).B조T2、T3화T4시점혈청Hcy측정치수유승고,여기출치비교차이무통계학의의(P＞0.05). 결론 병박분여칠불완균능인기노년환자단잠술후인지공능개변,지속흡입1.3최저폐포유효농도(minimum alveolar concentration,MAC)칠불미3.5 h대노년환자술후인지공능장애적영향비용3μg·kg-1·h-1～5 μg· kg-1·h-1적속솔빙주병백분3.5 h적영향대.기궤제지일가능여혈청Hcy적농도증가유관.
Objective The aim of this study is to observe the influence of sevoflurane or propofol anesthesia on postoperative cognitive functions of elderly patients and their serum homocysteine (Hcy).Methods Forty elderly patients,ASA Ⅰ-Ⅱ,undergoing gastrectomy surgery,were randomly divided into sevoflurane group (group A) and propofol group (group B).The venous blood sample was collected to test the homocysteine concentration by enzyme-linked immunosorbent assay (ELISA) at the begining of surgery(T1),2 h during the surgery(T2),24 h(T3) and 72 h after the surgery (T4).Meantime,the mini-mental state examination table (MMSE) was assessed.At 1 d before the surgery (S1),6 h (S2),24 h (S3) and 72 h after the surgery (S4).Results Compared with the preoperative values,the MMSE score of group B significantly decreased (P＜0.05) at S2,and the MMSE score of group A were lower than those of group B (P＜0.05).There was no significant difference between group in preoperative serum Hcy [group A:(5.8±1.4) μmol/L; group B:(5.9±1.6) μmol/L].Compared with the preoperative values,serum Hcy of group A (6.7±1.5) μmol/Lwere significantly higher at T2 (P＜0.05).However,serum Hcy decrease to the preoperative value level(P＞0.05) at T3 and T4.While in group B,the serum Hcy keep stable at T2,T3 and T4 (P＞0.05).Conclusions Both propofol and sevoflurane can cause shortterm postoperative cognitive functions in the elderly patients.Continuous inhalation of 1.3 MAC sevoflurane for 3.5 h has significant impact on postoperative cognitive dysfunctions than infusion of propofol at the rate of 3 μg·kg-1 ·h-1-5 μg·kg-1·h-1 for 3.5 h.One of its mechanisms may be associated with increased serum Hcy concentration.
