摘要
目的探讨七氟烷吸入麻醉与丙泊酚全凭静脉麻醉(total intravenous anesthesia,TIVA)对体外循环(cardiopulmonary bypass,CPB)下行心脏手术患者术后认知功能障碍(postoperative cognitive dysfunction,POCD)发生的影响。方法选取择期CPB下行心脏手术的患者50例,随机分为七氟烷组(术中持续吸入七氟烷2%~2.5%)和丙泊酚组[术中持续静脉泵注丙泊酚4~8 mg·(kg·h)^-1]各25例。应用蒙特利尔评估量表(montreal cognitive assessment,MOCA)评估患者术前1天、术后第1、3、7天的认知功能,观察丙泊酚与七氟烷对POCD发生的影响;应用ELISA法分别检测手术开始前(T1)、CPB结束时(T2)、术后24h(T3)3个时间点血清中S-100β蛋白和白介素-6(IL-6)水平。结果七氟烷组患者术后第3天POCD发生率高于丙泊酚组(P<0.05)。T2和T3时七氟烷组患者的IL-6水平均高于丙泊酚组(P均<0.05)。两组患者T2、T3时IL-6水平均高于T1(P均<0.05)。3个时间点两组患者S-100β水平差异均无统计学意义(P均>0.05)。七氟烷组患者T2时S-100β水平高于T1(P<0.05)。结论丙泊酚全凭静脉麻醉减少CPB下行心脏手术患者术后早期POCD的发生略有优势,且抑制促炎性细胞因子IL-6优于七氟烷吸入麻醉。
Objective To investigate the effect of inhalation anesthesia with sevoflurane and propofol total intravenous anesthesia on postoperative cognitive dysfunction in cardiac surgery patients undergoing cardiopulmonary bypass.Methods Totally 50 patients were scheduled for the cardiac surgery undergoing cardiopulmonary bypass,which were randomly divided into two groups.Patients in the sevoflurane group were given the continuous inhalation of sevoflurane 2%-2.5%.Patients in the propofol group were given the continuous intravenous infusion of propofol 4-8mg·(kg·h)^-1 with 25 cases each.The Montreal Cognitive Assessment(MOCA)was used to assess the postoperative cognitive dysfunction to observe the effect of propofol and sevoflurane in the incidence of POCD on day before operation and on the first,third and seventh day after operation.Serum S-100 beta protein and IL-6 levels were measured by ELISA before operation(T1),at the end of CPB(T2)and 24 hours after operation(T3)respectively.Results The incidence of POCD in group sevoflurane was higher than that in group propofol on the third day after operation(P<0.05).At T2 and T3 time points,the concentration of IL-6 in group sevoflurane was higher than that in group propofol(P all<0.05).The average level of IL-6 at T2 and T3 time points in both groups were higher than those at T1 time point(P all<0.05).There was no significant difference in the concentration of S-100 beta level between the two groups at three time points(P all>0.05).In group sevoflurane the concentration of S-100 beta level at T2 time point was higher than that at T1 time point(P<0.05).Conclusion The propofol based total intravenous anesthesia in cardiac surgery undergoing cardiopulmonary bypass has a slight advantage in reducing the incidence of early POCD,and inhibiting effect of the release of pro-inflammatory cytokine IL-6 is better than inhalation anesthesia with sevoflurane.
作者
张文娜
赵娜
张冬梅
尹甜甜
ZHANG Wenna;ZHAO Na;ZHANG Dongmei;YIN Tiantian(Department of Clinical Medicine,Ningxia Medical University,Yinchuan750004,China;Department of Anesthesiology,General Hospital of Ningxia Medical University,Yinchuan750004,China)
出处
《宁夏医科大学学报》
2019年第9期914-918,共5页
Journal of Ningxia Medical University
基金
宁夏医科大学校级课题(XM2018179)
关键词
七氟烷
丙泊酚
体外循环
术后认知功能障碍
sevoflurane
propofol
cardiopulmonary bypass
postoperative cognitive dysfunction
作者简介
张文娜(1994-),女,在读硕士研究生,研究方向:围术期心肌保护;通信作者:张冬梅,女,博士,教授,硕士研究生导师。E-mail:zdm_ych@hotmail.com。
