CAJ | 학술논문

目的：观察七氟醚在两种不同麻醉深度下对老年腹腔镜手术患者早期术后认知功能的影响。方法选择2013年5月~2014年10月深圳市龙岗区人民医院行腹部腹腔镜手术患者120例，采用随机数字表法将其分为麻醉较深组(Ⅰ组)和麻醉较浅组(Ⅱ组)，每组60例。两组患者均选择全身麻醉，术中吸入七氟醚维持麻醉，Ⅰ组维持BIS值35~45，Ⅱ组维持BIS值50~60，其余麻醉处理相同。采用简易精神状态评价量表(MMSE)于术前1 d、术后1、3、7 d对患者进行精神状态评分；手术前、后分别采集静脉血样，采用酶联免疫吸附法检测血清S100β蛋白水平。结果两组患者麻醉手术前MMSE评分差异无统计学意义(P>0.05)；两组患者术后1、3 d MMSE评分均较麻醉前明显下降(P<0.01)，且Ⅱ组MMSE评分明显低于Ⅰ组(P<0.05)；两组患者术后7 d MMSE评分均恢复到麻醉前水平(P>0.05)，Ⅱ组MMSE评分低于Ⅰ组，但差异无统计学意义(P>0.05)。Ⅰ组和Ⅱ组术后POCD的发生率比较[术后1 d：28.3%比36.7%；术后3 d：1.7%比21.7%；术后7d：1.7%比0.0%]，差异均无统计学意义(P>0.05)。术前两组血清S100β蛋白浓度差异无统计学意义(P>0.05)。术后1 d两组血清S100β蛋白浓度的均较麻醉前1 d明显升高(P<0.05)，且Ⅱ组血清S100β蛋白浓度明显高于Ⅰ组(P<0.05)；两组患者术后3、7 d血清S100β蛋白浓度均恢复到麻醉前水平(P>0.05)，两组血清S100β蛋白浓度比较，差异无统计学意义(P>0.05)。结论七氟醚吸入麻醉中，与较浅麻醉(BIS值50~60)比较，较深麻醉(BIS值35~45)可减少老年患者术后早期MMSE评分下降、抑制血清S100β蛋白水平升高，对老年腹腔镜手术患者早期术后认知功能的影响较小。
목적：관찰칠불미재량충불동마취심도하대노년복강경수술환자조기술후인지공능적영향。방법선택2013년5월~2014년10월심수시룡강구인민의원행복부복강경수술환자120례，채용수궤수자표법장기분위마취교심조(Ⅰ조)화마취교천조(Ⅱ조)，매조60례。량조환자균선택전신마취，술중흡입칠불미유지마취，Ⅰ조유지BIS치35~45，Ⅱ조유지BIS치50~60，기여마취처리상동。채용간역정신상태평개량표(MMSE)우술전1 d、술후1、3、7 d대환자진행정신상태평분；수술전、후분별채집정맥혈양，채용매련면역흡부법검측혈청S100β단백수평。결과량조환자마취수술전MMSE평분차이무통계학의의(P>0.05)；량조환자술후1、3 d MMSE평분균교마취전명현하강(P<0.01)，차Ⅱ조MMSE평분명현저우Ⅰ조(P<0.05)；량조환자술후7 d MMSE평분균회복도마취전수평(P>0.05)，Ⅱ조MMSE평분저우Ⅰ조，단차이무통계학의의(P>0.05)。Ⅰ조화Ⅱ조술후POCD적발생솔비교[술후1 d：28.3%비36.7%；술후3 d：1.7%비21.7%；술후7d：1.7%비0.0%]，차이균무통계학의의(P>0.05)。술전량조혈청S100β단백농도차이무통계학의의(P>0.05)。술후1 d량조혈청S100β단백농도적균교마취전1 d명현승고(P<0.05)，차Ⅱ조혈청S100β단백농도명현고우Ⅰ조(P<0.05)；량조환자술후3、7 d혈청S100β단백농도균회복도마취전수평(P>0.05)，량조혈청S100β단백농도비교，차이무통계학의의(P>0.05)。결론칠불미흡입마취중，여교천마취(BIS치50~60)비교，교심마취(BIS치35~45)가감소노년환자술후조기MMSE평분하강、억제혈청S100β단백수평승고，대노년복강경수술환자조기술후인지공능적영향교소。
Objective To investigate deferent depth of Sevofluence anesthesia on postoperative cognitive function (POCD) in elderly patients after early laparoscopic surgery. Methods From May 2013 to October 2014, in Shenzhen Longgang District People's Hospital, 120 elderly patients undergoing abdominal laparoscopic surgery were randomly di-vided into deeper anesthesia group (group Ⅰ) and shallow group (groupII) according random number table, with 60 cases in each group. All patients were given general anesthesia maintained with Sevofluence, and group Ⅰ maintained BIS value at 35-45 and groupII at 50-60. The rest anaesthesia managements were similar. In the preoperative and postoperative the mini mental state examination (MMSE) was evaluated for all patients and blood samples were collect-ed to determine the concentration of serum S100βprotein by ELISA. Results MMSE scores were not statistically signif-icant in two groups before surgery (P> 0.05). In the 1 d and 3 d after surgery MMSE scores in two groups decreased significantly compared with preoperative (P< 0.01), and the decline was significantly lower in group II than groupⅠ(P<0.05). The incidences of POCD in groupⅠ and groupII [1 d postoperative: 28.3% v s 36.7%; 3 d postoperative:1.7% v s 21.7%; 7d postoperative: 1.7% v s 0.0%] had no statistically significant difference (P> 0.05). Before surgery there was no statistically significant between the two groups in the concentration of S100β protein (P> 0.05). In 1 d postoperative it was significantly higher in both groups than 1 d preoperative (P>0.05), and group II increased signifi-cantly higher than group Ⅰ (P< 0.05). Conclusion In Sevofluence inhalation anesthesia deeper anesthesia (BIS value of 35-45) can reduce MMSE score, decreases and suppresses the elevation of concentration of S100β protein, and less impact on early postoperative cognitive function in elderly patients with laparoscopic surgery.