【摘要】：目的目前臨床上缺乏術(shù)后認(rèn)知功能障礙(postoperative cognitive dysfunction,POCD)客觀的診斷方法。文中通過(guò)比較丙泊酚及依托咪酯麻醉對(duì)患兒術(shù)后早期認(rèn)知功能及血清S100β蛋白水平的影響,探討其間相關(guān)性。方法收集桂林醫(yī)學(xué)院附屬醫(yī)院2013年7月至2014年11月1~3歲行腹腔鏡下疝修補(bǔ)術(shù)患兒的病例資料。排除既往有系統(tǒng)疾病、術(shù)后發(fā)生并發(fā)癥等任何影響認(rèn)知功能評(píng)估或不能配合完成全程測(cè)試的患兒。將最終納入的100例資料采用單純隨機(jī)法分為丙泊酚麻醉組(丙泊酚組)和依托咪酯麻醉組(依托咪酯組)各50例。2組患兒均于術(shù)前1 d及術(shù)后3 d采用貝莉嬰患兒認(rèn)知量表Ⅲ按月齡進(jìn)行相應(yīng)年齡段的認(rèn)知功能評(píng)估,并均按照Z(yǔ)計(jì)分法進(jìn)行POCD診斷。根據(jù)患兒是否發(fā)生POCD將每組進(jìn)一步分為POCD和NPOCD 2個(gè)亞組。同時(shí)丙泊酚組和依托咪酯組患兒分別于術(shù)前(T0)、出麻醉恢復(fù)室前(T1)抽取髂內(nèi)靜脈血5 m L,酶聯(lián)免疫吸附法檢測(cè)血清S100β蛋白濃度;比較2組組內(nèi)及組間POCD和NPOCD患兒血清S100β蛋白水平的改變。結(jié)果1丙泊酚組和依托咪酯組術(shù)后3 d分別有10(20.0%)和9(18.0%)名患兒發(fā)生POCD,組間POCD發(fā)生率比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);2與T0比較,2組患兒T1時(shí)血清S100β蛋白含量均升高,差異有統(tǒng)計(jì)學(xué)意義(P0.05);與NPOCD患兒比較,2組POCD患兒血清S100β蛋白含量均明顯升高,差異有統(tǒng)計(jì)學(xué)意義(P0.05);組間比較,T1時(shí)NPOCD患兒和POCD患兒血清S100β蛋白含量差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);3丙泊酚組與依托咪酯組患兒術(shù)畢血清S100β蛋白含量與術(shù)后3 d發(fā)生POCD相關(guān)(r=0.842,P=0.001;r=0.821,P=0.001)。結(jié)論丙泊酚或依托咪酯麻醉后可引起1~3歲患兒術(shù)后出現(xiàn)不同程度的認(rèn)知功能下降�；純郝樽砗笱錝100β蛋白含量升高與術(shù)后早期發(fā)生POCD具有正相關(guān)性,血清S100β蛋白含量升高能間接反映麻醉后患兒發(fā)生不同程度的腦損傷,并可作為患兒術(shù)后早期發(fā)生POCD的檢測(cè)指標(biāo)。丙泊酚及依托咪酯麻醉對(duì)患兒術(shù)后早期POCD發(fā)生率及麻醉后血清S100β蛋白含量變化無(wú)明顯差異。
[Abstract]:Objective to evaluate the lack of objective methods for the diagnosis of postoperative cognitive dysfunction (postoperative cognitive dysfunction,POCD). By comparing the effects of propofol and etomidate anesthesia on early cognitive function and serum S100 尾 protein level, the correlation between propofol and etomidate was discussed. Methods data of children with laparoscopic herniorrhaphy from July 2013 to November 1, 2014 in affiliated Hospital of Guilin Medical College were collected. Any children whose cognitive function can not be evaluated or who fail to complete the whole test are excluded from previous systemic diseases, postoperative complications and so on. 100 cases were randomly divided into propofol anesthesia group (propofol group) and etomidate anesthesia group (etomidate group). The cognitive function of children with cognitive scale 鈪，

本文編號(hào)：2331779