文章摘要
轻度认知功能障碍老年患者腰椎减压植骨融合术七氟醚复合丙泊酚的适宜配伍剂量
Appropriate compatibility of propofol and sevoflurane for posterior lumbar interbody fusion of patients with mild cognitive impairment
  
DOI：
中文关键词: 丙泊酚  七氟醚  轻度认知功能障碍  术后并发症  腰椎减压植骨融合术
英文关键词: Propofol  Sevoflurane  Mild cognitive impairment  Postoperative complications  Posterior lumbar interbody fusion
基金项目:国家自然科学基金 (81571054);天津市卫生行业重点攻关项目 (15KG117)
作者单位E-mail
陈一萌 300170,天津医科大学三中心临床学院,天津市第三中心医院麻醉科  
王海云 300170,天津医科大学三中心临床学院,天津市第三中心医院麻醉科 why819@126.com 
王红柏 天津医院麻醉科  
李平 天津医院麻醉科  
郭娣 300170,天津医科大学三中心临床学院,天津市第三中心医院麻醉科  
李唐 300170,天津医科大学三中心临床学院,天津市第三中心医院麻醉科  
瞿秋 300170,天津医科大学三中心临床学院,天津市第三中心医院麻醉科  
陈玲 300170,天津医科大学三中心临床学院,天津市第三中心医院麻醉科  
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中文摘要:
      目的 探讨轻度认知功能障碍 (mild cognitive impairment， MCI)老年患者腰椎减压植骨融合术七氟醚复合丙泊酚的适宜配伍剂量，以保护其认知功能。方法 选择择期行腰椎减压植骨融合术的患者80例，男41例，女39例，年龄65～75岁，BMI 17～26 kg/m2， ASA Ⅰ或Ⅱ级，术前通过蒙特利尔量表 (Montreal cognitive assessment，MoCA)、简易智力状态量表 (mini mental state examination， MMSE)、痴呆量表 (dementia scale， CDR)和日常生活能力量表 (daily living ability scale，ADL)评估认定为轻度认知功能障碍患者。采用随机数字表法将患者分为四组:TCI丙泊酚2.0～2.5 μg/ml组 (P组)、TCI丙泊酚1.2 μg/ml+七氟醚0.6 MAC组 (PS1组)、TCI丙泊酚0.6 μg/ml+七氟醚0.9 MAC组 (PS2组)和1.0～1.5 MAC七氟醚组 (S组)。在术前1 d (T0)、术后完全苏醒(T1)、3 d (T2)、7 d (T3)采用MMSE和MoCA量表评估患者认知功能，采用ELISA法测定血浆载脂蛋白J (apolipoprotein J，ApoJ)浓度。结果 与T0时比较，T1时四组MMSE和MoCA评分明显降低 (P<0.05)，T2时S组MMSE和MoCA评分明显降低 (P<0.05);与T1时比较，T2、T3时四组MMSE和MoCA评分明显升高 (P<0.05)。T1～T3时S组MMSE评分明显低于P组、PS1组和PS2组 (P<0.05);T2、T3时S组MoCA评分明显低于P组、PS1组和PS2组 (P<0.05)。与T0时比较，T1时四组血浆ApoJ浓度明显升高 (P<0.05);与T1时比较，T2、T3时四组血浆ApoJ浓度明显降低 (P<0.05)。T1～T3时S组和PS2组血浆ApoJ浓度明显高于PS1组 (P<0.05)。结论 MCI老年患者行腰椎减压植骨融合术时TCI丙泊酚1.2 μg/ml复合七氟醚0.6 MAC对老年患者认知功能影响较小，血浆ApoJ浓度较低。
英文摘要:
      Objective To investigate the appropriate compatibility of appropriate compatibility of sevoflurane and propofol for patients with mild cognitive impairment (MCI) undergoing posterior lumbar interbody fusion in order to protect their cognitive function. Methods Eighty patients, 41 males, 39 females, aged 65-75 years, BMI 17-26 kg/m2, ASA physical status Ⅰ or Ⅱ, scheduled to undergo elective posterior lumbar interbody fusion, were to be scored according to Montreal cognitive assessment (MoCA), mini mental state examination (MMSE), dementia scale (CDR) and daily living ability scale (ADL) to identify patients with MCI before the surgery. They were randomly assigned to 4 groups (n=20 each) using a random number table: TCI propofol 2.0-2.5 μg/ml group (group P), TCI propofol 1.2 μg/ml+sevoflurane 0.6 MAC group (group PS1), TCI propofol 0.6 μg/ml+sevoflurane 0.9 MAC group (group PS2), 1.0-1.5 MAC sevoflurane group (group S). MoCA and MMSE were used to evaluate the cognitive function of patients 1 d before the operation (T0), after patients become wide-awake (T1), 3 d and 7 d after operation (T2 and T3). Apolipoprotein J (ApoJ) concentration related to cognitive function in blood samples, which were drawn at T0-T3 would be measured with ELISA method. Results Compared with T0, the scores of MMSE and MoCA in four groups decreased significantly (P<0.05) at T1, the scores of MMSE and MoCA in group S decreased significantly (P<0.05) at T2; compared with T1, the score of MMSE in the four groups increased significantly at T2, T3 (P<0.05). The scores of MMSE at T1, T3 in group S decreased significantly compared with groups P, PS1 and PS2 (P<0.05). The scores of MoCA at T2, T3 in group S decreased significantly compared with groups P, PS1 and PS2 (P<0.05). Compared with T0, the concentration of plasma ApoJ in the four groups increased significantly at T1 (P<0.05). Compared with T1, the concentration of plasma ApoJ in the four groups decreased significantly at T2 and T3 (P<0.05). Compared with group PS1, the concentration of plasma ApoJ at T1, T3 increased significantly in groups S and group PS2 (P<0.05). Conclusion TCI propofol 1.2 μg/ml combined with 0.6 MAC sevoflurane group is the appropriate compatibility of sevoflurane and propofol for patients with MCI undergoing posterior lumbar interbody fusion,because it has less negative influence on cognitive function and lower concentration of plasma ApoJ.
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