CAJ | 학술논문

目的：探讨围术期脑氧饱和度（rSO2）与静吸复合依达拉奉麻醉下老年患者术后认知功能变化的关系，为临床麻醉提供指导。方法选取2013年1月到2014年1月期间在解放军总医院入院择期行腹部及下肢手术的60例美国麻醉医师协会（ASA）分级Ⅰ～Ⅱ级、年龄＞60岁的患者。随机分为3组：依达拉奉1组（E1组：30mg依达拉奉溶于100ml 0.9%NaCl）、依达拉奉2组（E2组：60mg依达拉奉溶于100ml 0.9%NaCl）和空白对照组（C组：100ml 0.9%NaCl），每组20例，麻醉后手术中30min静脉点滴完成。麻醉前均不用术前药，入室后给予阿托品0.5mg，缓慢静注丙泊酚、芬太尼、顺阿曲库铵快速诱导气管插管，机械通气，维持呼气末二氧化碳分压（Pet CO2）在正常范围，监测术中的rSO2变化。应用简易智力状态检查（MMSE）、连线测试及凹槽拼板测试来评定3组患者术前24h，术后4，8，12，24h的认知功能变化。结果（1）3组患者的一般情况比较差异无统计学意义（P＞0.05）；（2）3组患者术前MMSE、连线测试及凹槽拼板测试评分差异无统计学意义（P＞0.05）；（3）E2组和E1组患者术后认知测试评分均明显高于C组（P＜0.05），术中3组患者的rSO2数值水平差异无统计学意义（P＞0.05）。结论依达拉奉在静吸复合麻醉中的应用，能降低老年患者术后认知功能障碍的发生率，可能与其独特的神经保护，消除氧自由基、抑制脂质过氧化反应和调控凋亡相关基因表达有关，提高中枢对于缺血低氧的耐受力有关。
목적：탐토위술기뇌양포화도（rSO2）여정흡복합의체랍봉마취하노년환자술후인지공능변화적관계，위림상마취제공지도。방법선취2013년1월도2014년1월기간재해방군총의원입원택기행복부급하지수술적60례미국마취의사협회（ASA）분급Ⅰ～Ⅱ급、년령＞60세적환자。수궤분위3조：의체랍봉1조（E1조：30mg의체랍봉용우100ml 0.9%NaCl）、의체랍봉2조（E2조：60mg의체랍봉용우100ml 0.9%NaCl）화공백대조조（C조：100ml 0.9%NaCl），매조20례，마취후수술중30min정맥점적완성。마취전균불용술전약，입실후급여아탁품0.5mg，완만정주병박분、분태니、순아곡고안쾌속유도기관삽관，궤계통기，유지호기말이양화탄분압（Pet CO2）재정상범위，감측술중적rSO2변화。응용간역지력상태검사（MMSE）、련선측시급요조병판측시래평정3조환자술전24h，술후4，8，12，24h적인지공능변화。결과（1）3조환자적일반정황비교차이무통계학의의（P＞0.05）；（2）3조환자술전MMSE、련선측시급요조병판측시평분차이무통계학의의（P＞0.05）；（3）E2조화E1조환자술후인지측시평분균명현고우C조（P＜0.05），술중3조환자적rSO2수치수평차이무통계학의의（P＞0.05）。결론의체랍봉재정흡복합마취중적응용，능강저노년환자술후인지공능장애적발생솔，가능여기독특적신경보호，소제양자유기、억제지질과양화반응화조공조망상관기인표체유관，제고중추대우결혈저양적내수력유관。
ObjectiveTo investigate the relationship of peri-operative cerebraloxygen saturation (rSO2) with post-operative cognitive function in the elderly patients under edaravoneinjection combined with intravenous and inhalation anesthesia in orderto establish the guides for clinical anesthesia practice.Methods Sixty ASAⅠ-Ⅱ elderly patients (>60 years old) who were scheduled for selective abdominal surgeries or surgeries on lower limb in ourhospital from January 2013 to January 2014 were enrolled in the study. The patients were randomly divided into 3 groups (n=20), edaravone group 1 (E1:100ml 0.9% NaCl containing 30mg edaravone), edaravone group 2 (E2: 100ml 0.9% NaCl containing 60mg edaravone), and control group (C, 100ml 0.9% NaCl). The above fluids were intravenously infused in 30 min during operation. All patients were not premeditated before anesthesia and given with atropine 0.5mg until entering the operation room. Anesthesia was induced with intravenous infusionofpropofol, fentanyl andcisatracurium slowly. After tracheal intubation, all patients were mechanically ventilatedto maintain partial pressureofCO2at end-tidal(PetCO2)at normalrange. rSO2was continuously monitored and recordedduring operation. Mini-mentalstateexamination (MMSE), trail-makingtest, andgroovedpegboard test were used to access cognitive functionat24h before andat4, 8, 12 and24h after surgery.Results(1) Therewas no significantdifference in the general status among the 3 groups (P>0.05). (2) No obvious differencewas found in the scores of MMSE, trail-making test and grooved pegboard testamong the 3 groupsat 24h before operation (P>0.05). (3) The patients of groups E2 and E1had higher scores of cognitive tests than those of group C (P<0.05), but there was nodifference in the value of rSO2 among the 3 groups (P>0.05).Conclusion Edaravone injection combined with intravenous and inhalational anesthesia reduces the incidence of postoperative cognitive dysfunction in the elderly patients,whichmay be related toits unique neuroprotective effect, elimination of free oxygen radicals, inhibition of lipid peroxidation, regulation of the relative apoptotic genes, and enhancement of tolerance toischemia and hypoxiain centralnervous system.