本文關(guān)鍵詞： 老年患者 麻醉監(jiān)測 術(shù)后認(rèn)知功能障礙 Sβ蛋白　出處：《臨床麻醉學(xué)雜志》2017年02期 　論文類型：期刊論文

【摘要】：目的 觀察多重監(jiān)測下的全憑靜脈麻醉對老年患者術(shù)后認(rèn)知功能的影響。方法 選擇擇期行全麻下腹部手術(shù)患者100例,男56例,女44例,年齡65~80歲,ASAⅡ或Ⅲ級。采用隨機數(shù)字表法分為多重監(jiān)測組(M組)和常規(guī)監(jiān)測組(R組),每組50例。M組通過調(diào)節(jié)麻醉藥物使麻醉深度指數(shù)(NTI)維持在37~56,rSO250%或不低于基礎(chǔ)值的20%,根據(jù)TOF值輸注肌松藥物;R組術(shù)中由麻醉醫(yī)師根據(jù)監(jiān)護儀指標(biāo)調(diào)整丙泊酚、瑞芬太尼及肌松藥物的輸注速率。于術(shù)前1d、術(shù)后1、3、7d、1個月和3個月采用MMSE量表評估認(rèn)知功能,記錄術(shù)后7d、1個月和3個月的術(shù)后認(rèn)知功能障礙(postoperative cognitive dysfunction,POCD)的發(fā)生情況。記錄術(shù)畢至呼喚睜眼時間、術(shù)畢至拔管時間和術(shù)畢至定向力恢復(fù)時間;記錄單位時間丙泊酚、瑞芬太尼和順式阿曲庫銨用量。于麻醉前(T0)、手術(shù)開始1h(T1)、術(shù)畢(T2)、術(shù)后24h(T3)采集靜脈血標(biāo)本,采用ELISA法測定血清S100β和Aβ1-42蛋白含量。結(jié)果 M組術(shù)后1d認(rèn)知功能下降發(fā)生率明顯低于R組(8%vs.22%,P0.05)、術(shù)后3d認(rèn)知功能下降發(fā)生率明顯低于R組(2%vs.16%,P0.05)。術(shù)后7d和1個月、3個月兩組POCD的發(fā)生差異無統(tǒng)計學(xué)意義。M組丙泊酚用量明顯小于R組[(3.3±0.8)mg·kg~(-1)·h~(-1) vs.(3.7±0.7)mg·kg~(-1)·h~(-1),P0.05],順式阿曲庫銨用量明顯小于R組[(104±47)μg·kg~(-1)·h~(-1) vs.(124±68)μg·kg~(-1)·h~(-1),P0.05],術(shù)畢至呼喚睜眼時間[(10±3)min vs.(16±6)min,P0.01]、拔管時間[(13±3)min vs.(22±7)min,P0.01]和定向力恢復(fù)時間[(17±4)min vs.(27±9)min,P0.01]均明顯短于R組。與T0時比較,T1、T2時M組和T1~T3時R組血清S100β蛋白含量明顯升高(P0.05),T_1~T_3時M組血清S100β蛋白含量明顯低于R組(P0.05)。與T_0時比較,T_1、T_2時兩組Aβ1-42蛋白含量明顯降低(P0.05)。結(jié)論 多重監(jiān)測下的全憑靜脈麻醉可減輕腹部手術(shù)老年患者神經(jīng)損傷,降低術(shù)后早期認(rèn)知功能下降發(fā)生率,但對術(shù)后認(rèn)知功能障礙的發(fā)生無明顯影響。
[Abstract]:Objective To observe the effect of multiple monitoring under the influence of total intravenous anesthesia on postoperative cognitive function in elderly patients undergoing general anesthesia. Methods 100 cases of abdominal surgery patients, male 56 cases, female 44 cases, age 65~80 years old, ASA II or III, were randomly divided into multiple monitoring group (M group) and routine monitoring group (R group), 50 cases in each.M group by adjusting the anesthetic depth of anesthesia to index (NTI) at 37~56, rSO250% or not less than the base value of 20%, according to the TOF value of muscle relaxant drug infusion; R group by the anesthesiologist according to the monitor index to adjust the infusion rate of remifentanil and propofol. Muscle relaxants. Preoperative 1D, postoperative 1,3,7d, 1 months and 3 months with the MMSE scale to assess cognitive function, postoperative 7d, 1 months and 3 months postoperative cognitive dysfunction (postoperative cognitive, dysfunction, POCD). The incidence of postoperative record to call eyes when 闂，

本文編號：1547840