文章摘要
异氟醚和七氟醚对老年患者术后认知功能的影响
Effects of isoflurane versus sevoflurane on postoperative cognitive function in old patients
  
DOI：10.12089/jca.2018.02.012
中文关键词: 异氟醚  七氟醚  认知功能  β淀粉样蛋白
英文关键词: Isoflurane  Sevoflurane  Cogntive function  β-amyloid
基金项目:贵州省科技计划项目(黔科合基础［2016］1089);贵州省人民医院博士基金(GZSYBS ［2015］05);贵州省科技合作计划(黔科合LH字 ［2015］7141);贵阳市科技计划筑科合同(［20141001］60号)
作者单位E-mail
刚绍鹏 550002,贵阳市,贵州省人民医院麻醉科  
方开云 550002,贵阳市,贵州省人民医院麻醉科 fangkaiyun@sina.cn 
马熠 550002,贵阳市,贵州省人民医院麻醉科  
何祥 550002,贵阳市,贵州省人民医院麻醉科  
文静 550002,贵阳市,贵州省人民医院麻醉科  
张艳春 550002,贵阳市,贵州省人民医院麻醉科  
朱焱 贵州医科大学公共卫生学院卫生统计学教研室  
李春陵 550002,贵阳市,贵州省人民医院干部医疗保健科  
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中文摘要:
      目的 观察异氟醚和七氟醚麻醉对老年患者术后12个月认知功能和血清β淀粉样蛋白(β-amyloid, Aβ)浓度的影响。方法 选择全麻下行腹部手术患者77例, 男43例, 女34例, 年龄65～75岁, ASA Ⅰ～Ⅲ级, 采用随机数字表法分为两组: 异氟醚组(I组, n=32)和七氟醚组(S组, n=45)。采用简易精神状态量表(mini-mental state examination, MMSE)于术前1 d、术后3 d和术后12个月进行认知功能评分。同时留取患者血清, 于以上时点测定Aβ40和Aβ42浓度。结果 术后3 d I组和S组的MMSE评分明显低于术前(P＜0.05),且I组明显低于S组(P＜0.05);术后12个月I组和S组POCD发生率差异无统计学意义[13例（40.6%） vs 15例（33.3%）]。两组不同时点血清Aβ42和Aβ40浓度差异无统计学意义。结论 七氟醚对近期认知功能的影响小于异氟醚, 但长期的影响可能是一致的;两者对患者术后12个月血清β淀粉样蛋白浓度无影响。
英文摘要:
      Objective To compare the effects of isoflurane compare sevoflurane on postoperative cognitive function and the level of serum β-amyloid in elder patients at 12 months after surgery. Methods Seventy-seven patients undergoing abdominal surgery, 43 males and 34 females, aged 65-75 years, ASA physical status Ⅰ-Ⅲ, were divided into two proups: isoflurane group (group I, n=32) and sevoflurane group (group S, n=45). The patients' cognitive function were assessed using mini-mental state examination (MMSE) 1 d before operation, 3 d and 12 months after opertion. Blood samples were taken before operation, 3 d and 12 monthes after operation for determination of serum Aβ42 and Aβ40 concentrations. Results The MMSE scores of the two groups 3 d after operation were significantly lower than those before operation (P＜0.05). The MMSE score 3 d after operation in group I was significantly lower than that in group S (P＜0.05). The incidence of cognitive dysfunction 12 months after operation had no significant difference between two groups ［13 (40.6%) cases vs 15 (33.3%) cases］. There was no significant difference in the serum Aβ42 and Aβ40 concentration between groups. Conclusion Sevoflurane has less effect on postoperative cognitive function in short time than isoflurane, but its long-term effect seemed to be similar. The levels of Aβ42 and Aβ40 showed no difference between two groups.
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