摘要
目的观察不同麻醉方案对患者术后认知功能及S100β蛋白的影响。方法采用前瞻性随机对照研究方法，选择天津市胸科医院2013年11月至2014年7月收治的90例非体外循环下冠状动脉旁路移植术（op—CABG）患者，按随机数字表法分为P1、P2、P3组，每组30例，麻醉维持分别采取丙泊酚靶控（TCI）〈2．0μg／mL、2．0～3．0μg／mL和〉3．0～4．0μg，mL。比较3组患者手术时间、麻醉时间、丙泊酚用量及术后认知功能障碍（POCD）发生率；麻醉诱导前（T0）、麻醉诱导完成时（T1）、气管插管后（T2）、切皮时（T3）、手术中1h（T4）、手术中2h（T5）、手术结束时（T6）观察麻醉深度指数（NTI）及血流动力学水平；麻醉诱导前（Ta）、手术中2h（Th）、手术结束时（Tc）、术后6h（Td）、术后24h（Te）检测血清S100β蛋白水平。结果3组患者手术时间、麻醉时间比较差异均无统计学意义（均P〉0．05）；P2组、P3组丙泊酚用量明显多于P1组（mg：1746.3±43．9、2332．7±42．8比968．5±35．6，均P〈0．05）；P2组、P3组POCD发生率均低于P1组（10．00％、6．67％比33．33％，均P〈0．05）。随麻醉时间延长，3组NTI均逐渐降低，P3组T6时有所升高，且P3组T1后各时间点NTI均低于P1及P2组（均P〈0．05）；P1、P2、P3组平均动脉压（MAP）呈现先降后升的趋势，升高拐点均在T2时，P1组升高持续至T4，T5时开始下降，P2、P3组则从T4开始下降；3组心率（HR）则呈先升后降的趋势，降低拐点均在T3时；至T6时，P3组MAP、HR均明显低于P1及P2组[MAP（mmHg，1mmHg=0．133kPa）：74．9±8-3比85．3±11．2、84．2±10．1；HR（次／min）：74．1±4．2比80．9±8．1、78．7±7．9，均P〈0．05j。3组Th起血清S100B蛋白含量即均较Ta明显升高，Tc达峰值，Td开始下降，Te接近Ta水平，但P2组、P3组均低于P1组（mg/L：1．05±0．22、1．04±0．21比1．33±0．22，均P〈0．05）。结论采取丙泊酚TCI2．0～3．0μg／mL麻醉维持既可达到较满意的麻醉深度，又能减轻对血流动力学的影响，并降低了血清S100蛋白水平及POCD发生率。
Objective To observe the effects of different anesthetic solutions on postoperative cognitive function and serum S100β protein levels. Methods A prospective randomized controlled trial was conducted. Ninety patients necessary to perform off-pump coronary artery bypass grafting （op-CABG） in Tianjin Chest Hospital from November 2013 to July 2014 were enrolled. They were divided into three groups by random number table： P1, P2 and P3 groups, 30 cases in each group. The anesthesia was maintained with propofol by target-controlled infusion （TCI） in all the patients in the three groups, and the respective dosages were 〈 2.0 μg/mL, 2.0 - 3.0 μg/ml, and 〉 3.0 - 4.0 ±g/mL. The operation time, anesthesia time, dosages of propofol and the incidence of postoperative cognitive dysfunction （POCD） were compared among the three groups. At the following times： before induction of anesthesia （TO）, completion of anesthesia induction （T1）, after tracheal intubation （T2）, skin incision （T3）, 1 hour after operation （T4）, 2 hours after operation （T5） and the end of operation （T6）, the narcotrend index （NTI） and hemodynamic levels were observed; the serum S100β protein levels were measured at the following times： before induction of anesthesia （Ta）, 2 hours after operation （Tb）, the end of operation （Tc）, postoperative 6 hours （Td） and postoperative 24 hours （Te）. Results There were no significant differences in operation times and anesthesia times among three groups （all P 〉 0.05）; dosages of propofol in P2 and P3 groups were obviously higher than those of PI group （mg： 1 746.3 ± 43.9, 2 332.7 ± 42.8 vs. 968.5 ± 35.6, both P 〈 0.05）, and the incidences of POCD in P2 and P3 groups were lower than that in P1 group （10.00%, 6.67% vs. 33.33%, both P 〈 0.05）. With the extension of anesthesia time, the level of NTI was gradually declined in each group, in P3 group, it was occasionally increased at T6, and beginning from time point T1 afterwards, the NTI levels were lower than those of P1 and P2 groups at all the time points （all P 〈 0.05）; the mean arterial pressure （MAP） in the three groups had a tendency of firstly going down and then increasing, and the inflection point being at T2, in PI group, the elevation of MAP level persisted to T4, and it began to decline at T5, while in P2 and P3 groups, the levels started to decline at T4; the heart rate （HR） in three groups showed a tendency of firstly going up and then declining, and the inflection point being at T3, until T6, in P3 group, MAP and HR were all lower than those of P1 and P2 groups, the differences being statistically significant [MAP （mmHg, 1 mmHg = 0.133 kPa）： 74.9 ± 8.3 vs. 85.3 ± 11.2, 84.2 ± 10.1;HR （bpm）： 74.1 ± 4.2 vs. 80.9 ± 8.1, 78.7 ± 7.9, all P 〈 0.05]. The serum S100β protein levels of three groups at Tb began to he obviously higher than those at Ta, and reached the peak points at Tc, then the levels started to decline until Td, and the levels at Te was approximately close to those of Ta, but the serum S100β protein levels in P2 and P3 groups were lower than that in P1 group, the differences being statistically significant （mg/L： 1.05 ± 0.22, 1.04 ± 0.21 vs. 1.33 ± 0.22, both P 〈 0.05）. Conclusion Application of propofol by TCI 2.0 - 3.0 μg/mL for maintenance of anesthesia can achieve the satisfactory depth of anesthesia, and it not only can reduce the effects on hemodynamics, but also can decrease the serum S100β protein level and the incidence of POCD.
出处
《中国中西医结合急救杂志》
CAS
北大核心
2015年第4期398-401,共4页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
天津市卫生行业重点攻关项目（12KG125）
