發(fā)布時(shí)間：2018-12-27 15:04

【摘要】：目的： 本課題旨在探討麻醉方法對(duì)Klotho蛋白含量的變化是否與老年患者POCD的發(fā)生存在關(guān)系,為我國(guó)研究老年患者POCD的發(fā)生提供了新的研究方向。 方法： 選擇65歲以上ASAI-II級(jí)擬行全身麻醉的老年患者70例,其中男性38例,女性32例。既往無(wú)手術(shù)史和中樞神經(jīng)系統(tǒng)疾病史。將上述患者采用抽簽法隨機(jī)分為2組,即全憑靜脈麻醉組標(biāo)為T組,吸入麻醉組標(biāo)為I組。分別選擇對(duì)患者在術(shù)前1天,術(shù)后第1天以及第3天進(jìn)行精神狀態(tài)檢查量表MMSE的評(píng)估。.麻醉誘導(dǎo)：咪達(dá)唑侖0.1-0.15mg/kg、芬太尼0.002-0.004mg/kg、依托咪酯0.15-0.3mg/kg、維庫(kù)溴銨0.1mg/kg。術(shù)中麻醉維持：T組采用微量泵給與異丙酚3-6mg·kg-1·h-1、瑞芬太尼0.05-0.20μg·kg-1·min-1、術(shù)中維庫(kù)溴銨間斷給藥；,I組根據(jù)患者體重等指標(biāo)采用吸入3-5%的異氟醚,且術(shù)中同樣給與維庫(kù)溴銨間斷給藥。手術(shù)開(kāi)始后T組根據(jù)患者的當(dāng)時(shí)血壓,心率情況及時(shí)調(diào)整丙泊酚或瑞芬太尼的劑量,加大或減小劑量等；而I組也同樣根據(jù)患者血壓,心率情況調(diào)整吸入麻醉藥異氟醚的劑量,選擇加大或減小吸入量。分別于手術(shù)麻醉前設(shè)為T1,手術(shù)結(jié)束麻醉停藥后設(shè)為T2兩個(gè)時(shí)間點(diǎn)抽取靜脈血,并采用ELISA技術(shù)對(duì)血清中Klotho蛋白的含量進(jìn)行測(cè)量。 結(jié)果： 1.術(shù)后1天POCD的發(fā)生率為37.88%,第3天均恢復(fù)正常。 2.ELISA技術(shù)測(cè)量術(shù)后Klotho蛋白的含量較術(shù)前的含量明顯降低,且發(fā)生POCD的患者中術(shù)后Klotho蛋白的含量下降的更為明顯。 結(jié)論： 術(shù)后認(rèn)知功能障礙的發(fā)生可能與Klotho基因之間存在著一定的聯(lián)系,全憑靜脈和吸入兩種麻醉方法都可以導(dǎo)致患者體內(nèi)Klotho蛋白的下降,吸入麻醉造成的老年患者體內(nèi)Klotho蛋白值比全憑靜脈麻醉下降的更顯著。
[Abstract]:Objective: to explore the relationship between the changes of Klotho protein and the occurrence of POCD in elderly patients, and to provide a new research direction for the study of POCD in elderly patients in China. Methods: seventy elderly patients (38 males and 32 females) with ASAI-II grade over 65 were selected for general anesthesia. There was no history of surgery or central nervous system disease. The patients were randomly divided into two groups: total intravenous anesthesia group as T group and inhalation anesthesia group as group I. Patients were assessed with mental state scale (MMSE) 1 day before operation, 1 day after operation and 3 days after operation. Anesthesia induction: midazolam 0.1-0.15 mg / kg, fentanyl 0.002-0.004 mg / kg, etomidate 0.15-0.3 mg / kg, vecuronium 0.1 mg / kg. Anesthesia maintenance: group T was given propofol 3-6mg kg-1 h-1 by micropump, remifentanil was administered intermittently by vecuronium during operation with remifentanil 0.05-0.20 渭 g kg-1 min-1,. Group I was inhaled 3-5% isoflurane according to the patient's body weight and was also given vecuronium intermittently during the operation. After operation, T group adjusted the dose of propofol or remifentanil in time according to the patient's blood pressure and heart rate, and increased or decreased the dose. Group I also adjusted the dose of inhaled anesthetic isoflurane according to the patient's blood pressure and heart rate. The venous blood was taken at T 1 before operation and T 2 at the end of operation, and the content of Klotho protein in serum was measured by ELISA technique. Results: 1. The incidence of POCD was 37.88 on the first day after operation and returned to normal on the third day. The content of Klotho protein was significantly decreased by 2.ELISA technique, and the content of Klotho protein was significantly decreased in the patients with POCD. Conclusion: there may be some relationship between the occurrence of postoperative cognitive dysfunction and Klotho gene. Both intravenous and inhaled anesthesia can lead to the decrease of Klotho protein in patients. The levels of Klotho protein in elderly patients with inhaled anesthesia were significantly lower than those of intravenous anesthesia alone.
【學(xué)位授予單位】：延邊大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R614

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