| 郭鹏飞,姚玲玲,李长生.丙泊酚复合不同浓度七氟醚麻醉对老年术后认知障碍的影响[J].安徽医药,2023,27(6):1130-1135. |
| 丙泊酚复合不同浓度七氟醚麻醉对老年术后认知障碍的影响 |
| Effects of propofol combined with sevoflurane anesthesia with different compatibility on postoperative cognitive impairment in elderly patients |
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| DOI：10.3969/j.issn.1009-6469.2023.06.016 |
| 中文关键词: 麻醉，全身 丙泊酚 七氟醚 术后认知功能障碍 超氧化物歧化酶 磷酸丙酮酸水合酶 老年人 |
| 英文关键词: Anesthesia, general Propofol Sevoflurane Postoperative cognitive impairment Superoxide dismutase Phosphopyruvate hydratase Aged |
| 基金项目:国家自然科学基金委员会项目( U1504807) |
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| 中文摘要: |
| 目的探讨丙泊酚复合七氟醚不同配伍麻醉对老年术后认知障碍的影响。方法选取平顶山市第一人民医院 2020年 1月至 2021年 6月收治的股骨颈骨折需行手术治疗的老年病人 135例，根据麻醉方法不同分为低浓度七氟醚组( n=67)和高浓度七氟醚组( n=68)。低浓度七氟醚组采用靶控输注丙泊酚血浆靶浓度 0.6 mg/L和吸入浓度为 1.2%的七氟醚进行麻醉维持；高浓度七氟醚组采用靶控输注丙泊酚血浆靶浓度 0.6 mg/L和吸入浓度为 1.7%的七氟醚进行麻醉维持。比较两组病人简易智力状态检查量表( MMSE)评分、载脂蛋白 J(ApoJ)、神经元特异性烯醇化酶( NSE)、神经生长因子( NGF)水平，氧化应激反应指标超氧化物歧化酶( SOD)、丙二醛和总抗氧化能力( T-AOC)水平和生命体征指标心率、平均动脉压( MAP)、血氧饱和度(SpO2)以及不良反应发生率。结果术后 6、24、72 h高浓度七氟醚组 MMSE评分［( 25.61±2.16)分、(27.41±2.38)分、(28.02± 1.22)分］高于低浓度七氟醚组［( 23.47±2.23)分、(25.46±2.08)分、(27.13±2.15)分］(P<0.05)；术后 1、3、7d时 ApoJ水平［( 145.36±14.27)mg/L、(139.57±12.78)mg/L、(130.39±12.62)mg/L］、 NSE水平［( 9.66±2.54)μg/L、(7.38±2.12)μg/L、(5.88±1.58) μg/L］高于低浓度七氟醚组［( 130.64±10.58)mg/L、(125.37±11.21)mg/L、(123.11±11.34)mg/L、(7.22±1.48)μg/L、(6.11±1.71)μg/ L、(4.22±1.24)μg/L］， NGF水平［( 290.46±37.38)μg/L、(315.11±39.16)μg/L、(358.39±43.44)μg/L］低于低浓度七氟醚组［( 327.23±40.25)μg/L、(345.44±40.66)μg/L、(395.23±38.48)μg/L］(P<0.05)；高浓度七氟醚组术后 MAP(78.28±6.43)mmHg、心率( 85.36±6.42)次 /min、SpO2(96.52±4.22)%水平均高于低浓度七氟醚组( 74.28±6.21)mmHg、(78.16±6.32)次 /min、(94.25±4.18)%(P<0.05)；术后 1、6h高浓度七氟醚组丙二醛水平［( 5.87±0.54)mmol/mL、(2.65±0.32)mmol/mL］低于低浓度七氟醚组［( 7.14±0.46)mmol/mL、(4.09±0.47)mmol/mL］，而 SOD水平［( 87.22±13.59)U/mL、(66.69±10.58)U/mL］和 T-AOC水平［( 20.53±4.20)U/mL、(22.24±3.38)U/mL］高于低浓度七氟醚组［( 73.44±14.31)U/mL、(57.41±9.78)U/mL、(18.49±3.48)U/mL、(20.14±3.01)U/mL］(P<0.05)；两组不良反应发生率比较，差异无统计学意义(P>0.05)。结论靶控输注 0.6 mg/L丙泊酚和吸入浓度为1.7%的七氟醚可有效促进老年病人认知功能的恢复，且不会增加不良反应。 |
| 英文摘要: |
| Objective To investigate the effect of propofol combined with sevoflurane in different compatibility anesthesia on postoperative cognitive impairment in elderly patients.Methods A total of 135 elderly patients with femoral neck fracture who needed surgical treatment in the First People′s Hospital of Pingdingshan City from January 2020 to June 2021 were included and divided into lowconcentration sevoflurane group (n=67) and high concentration sevoflurane group (n=68) according to different anesthesia methods. Anesthesia in the low concentration sevoflurane group was maintained by target controlled infusion of propofol with plasma target concentration of 0.6 mg/L and sevoflurane with inhalation concentration of 1.2%. Patients in the high concentration sevoflurane group wereanesthetized by target controlled infusion of propofol with a plasma target concentration of 0.6 mg/L and sevoflurane was administeredwith inhalation concentrations 1.7%. The mini-mental state examination (MMSE) score, apolipoprotein J (ApoJ), neuron specific enolase (NSE), nerve growth factor (NGF), levels of superoxide dismutase (SOD), malondialdehyde (MDA) and total antioxidant capacity (TAOC), hemodynamic indexes heart rate, mean arterial pressure (MAP), oxygen saturation (SpO2) and the incidence of adverse reactions were observed and the differences were compared between the two groups.Results At 6 h, 24 h and 72 h after operation, the MMSEscores of the high concentration sevoflurane group [(25.61±2.16) score, (27.41±2.38) score, (28.02±1.22) score] were higher than thoseof the low concentration sevoflurane group [(23.47±2.23) score, (25.46±2.08) score, (27.13±2.15) score] (P<0.05). At 1, 3 and 7 days after operation, the levels of APOJ [(145.36±14.27) mg/L, (139.57±12.78) mg/L, (130.39±12.62) mg/L] and NSE [(9.66±2.54) μg/L,(7.38±2.12) μg/L, (5.88±1.58) μg/L] were higher than those in the low concentration sevoflurane group [(130.64±10.58) mg/L (125.37±11.21) mg/L (123.11±11.34) mg/L (7.22±1.48) μg/L, (6.11±1.71) μg/L, (4.22±1.24) μg/L], while the levels of NGF [(290.46±37.38) μg/L, (315.11±39.16) μg/L, (358.39±43.44) μg/L] were lower than those in the low concentration sevoflurane group [(327.23±40.25) μg/L,(345.44±40.66) μg/L, (395.23±38.48) μg/L] (P<0.05). The postoperative MAP (78.28±6.43) mmHg, heart rate (85.36±6.42) times/min and SpO2 (96.52±4.22) % in the high concentration sevoflurane group were higher than those in the low concentration sevoflurane group(74.28±6.21) mmHg, (78.16±6.32) times/min, (94.25±4.18) % (P<0.05). At 1 h and 6 h after operation, the levels of MDA [(5.87±0.54)mmol/mL, (2.65±0.32) mmol/mL] in the high concentration sevoflurane group were lower than those in the low concentration sevoflurane group [(7.14±0.46) mmol/mL, (4.09±0.47) mmol/mL], while the levels of SOD [(87.22±13.59) U/mL, (66.69±10.58) U/mL] and TAOC [(20.53±4.20) U/mL, (22.24±3.38) U/mL] were higher than those in the low concentration sevoflurane group [(73.44±14.31) U/mL,(57.41±9.78) U/mL, (18.49±3.48) U/mL, (20.14±3.01) U/mL] (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05).Conclusion Target controlled infusion of 0.6 mg/L propofol and inhaled sevoflurane with aconcentration of 1.7 % can effectively promote the recovery of cognitive function in elderly patients without increasing adverse reactions. |
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