天津医药

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七氟烷和异氟烷对老年非体外循环冠状动脉旁路移植术患者术后认知功能的影响

王准1,薛玉良2,韩建阁2   

  1. 1. 天津市胸科医院
    2.
  • 收稿日期:2009-09-17 修回日期:2009-12-13 出版日期:2010-04-15 发布日期:2010-04-15
  • 通讯作者: 王准

Effects of Sevoflurane and Isoflurane on postoperative cognitive function in elderly patients undergoing off-pump Coronary Artery Bypass Grafting

  • Received:2009-09-17 Revised:2009-12-13 Published:2010-04-15 Online:2010-04-15

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摘要： 【摘要】 目的：通过比较七氟烷和异氟烷吸入麻醉下老年非体外循环冠状动脉旁路移植术（OPCABG）患者术后的认知功能，探讨其适宜的麻醉用药方法。方法：择期拟行OPCABG的冠心病患者60例，年龄65～82岁，心功能Ⅱ或Ⅲ级。随机分为七氟烷组（S组）和异氟烷组（I组），每组30例。于麻醉诱导后（T0）、术毕（T1）、术后6 h（T2）和术后24 h（T3）4个时间点采集颈内静脉球部血5 ml，测定血清S-100蛋白和神经元特异性烯醇化酶（NSE）浓度。分别于麻醉前1 d和术后3、7 d时对患者进行简易智能状态检查（MMSE）评分，MMSE总分30分，<24分为认知功能障碍。结果：两组患者一般情况比较，差异无统计学意义，术后所有患者镇痛效果均良好。两组患者均完成MMSE，S组术后7 d内共有4例发生认知功能障碍，发生率为13％；I组术后7 d内共有6例发生认知功能障碍，发生率为20％（P<0.05）。两组术后3、7 d MMSE评分均低于同组术前1 d MMSE评分（P<0.05）。两组患者血清S-100蛋白和NSE浓度于手术开始后升高，T1时达到高峰（P<0.05），T2时已出现下降趋势，但仍高于基础值（P<0.05），至T3时均恢复至基础水平（P>0.05）；与I组比较，T1和T2时S组血清S-100蛋白和NSE浓度降低（P<0.05）。结论：在非体外循环冠状动脉旁路移植术过程中，采用吸入七氟烷维持麻醉比异氟烷脑损伤程度轻，可降低老年患者术后认知功能障碍的发生率，是一种可以推荐采用的预防心脏术后认知功能障碍的麻醉方法。

关键词: 七氟烷, 异氟烷, 心肺转流术, 冠状动脉旁路移植术, 认知功能

Abstract: 【Abstract】 Objective：To discuss the feasible anesthesia method in elderly patients undergoing off-pump Coronary Artery Bypass Grafting(OPCABG) through compare the postoperative cognitive function between Sevoflurane and Isoflurane inhaled anesthesia. Methods：Sixty undergoing elective OPCABG patients aged 65~82,heart function Ⅱ or Ⅲ ,were randomly divided into two groups: Sevoflurane group(S,n=30) and Isoflurane group(I,n=30).The blood samples of internal jugular vein were taken for determination of serum S-100 protein,neuronspecific enolase(NSE) content at the moment after anesthesia induction(T0),the end of operation(T1),6 h after operation(T2) and 24 h after operation(T3).A mini-mental state examination(MMSE) was performed 1 d before and 3,7 d after operation by an experienced psychometrician.The total scores of MMSE was 30 points.Those scores not reach 24 points were defined as postoperative cognitive dysfunction(POCD). Results：There was no significant difference in general conditions between both groups(P>0.05).All patients completed MMSE.The incidence of POCD within 7 d after operation in group I(20%) was higher than that in group S(13%)(P<0.05).The scores of MMSE at 3,7 d after operation were lower than that at 1 d before operation in both groups(P>0.05).The contents of serum S-100 protein and NSE increased at the initial stages of operation,reached peak at T1(P<0.05),then decreased at T2 (P<0.05),and returned to baseline level at T3 in both groups(P>0.05).The contents of serum S-100 protein and NSE were lower in group S than those in group I at T1 and T2(P<0.05). Conclusion： Sevoflurane can cause slighter cerebral injury and lower incidence of POCD than Isoflurane in elderly patients undergoing OPCABG,which is a recommendable anesthesia method that could be used for prevent cognitive dysfunction after heart operation.

Key words: Sevoflurane, Isoflurane, Cardiopulmonary bypass, Coronary artery bypass grafting, Cognitive function