不同麻醉药物对老年非体外循环冠状动脉旁路移植术患者血清兴奋性氨基酸的影响

Effects of different anaesthetics on serum excitatory amino acids in elderly patients undergoing off-pump coronary artery bypass grafting

摘要:

目的 比较不同麻醉药对老年非体外循环冠状动脉旁路移植术患者血清兴奋性氨基酸（EAA）的影响。方法 择期行非体外循环冠状动脉旁路移植术的患者120例，年龄60～75岁，ASA（美国麻醉医师协会）Ⅱ或Ⅲ级，随机分为丙泊酚复合瑞芬太尼组（P组）和七氟烷（S组），每组60例。P组丙泊酚复合瑞芬太尼，S组吸入七氟烷维持麻醉。分别于麻醉前（T0）、术毕即刻（T1）、术后24h（T2）、48h（T3）、72h（T4）从颈内静脉采血2ml，采用反相高效液相色谱荧光法检测血清中EAA浓度。结果 组内比较T2、T3两组血清谷氨酸（Glu）、天冬氨酸（Asp）、甘氨酸（Gly）浓度与麻醉前均有不同程度升高（P＜0.05）；与P组比较S组Glu、Asp、Gly浓度在T2明显升高（P＜0.05），Glu浓度在T3明显升高（P＜0.05），T1和T4 Glu、Asp、Gly浓度与P组比较，差异无统计学意义（P＞0.05）。结论 非体外循环冠脉搭桥术老年患者应用丙泊酚复合瑞芬太尼麻醉，可降低血清EAA浓度，有减少术后认知功能障碍的趋势。

Abstract:

Objective To compared the effect of different anaesthetic drugs on the serum levels of excitatory amino acids (EAA) in the elderly undergoing off-pump coronary artery bypass grafting. Methods One hundred and twenty patients at America Society of Anesthesiologist (ASA) Ⅱ or Ⅲ and aged 60 to 75 years who undergoing selective off-pump coronary artery bypass grafting in our department were enrolled in this study. They were randomly divided into propofol and remifentanil group (group P) and sevoflurane (group S) (n＝60 for each group). Group P received propofol and remifentanil to maintain anesthesia, and group S inhaled sevoflurane at the end-tidal concentration of 1.0%～1.5% during anesthesia. Blood samples were harvested from the internal jugular vein before anesthesia (T0), immediately after surgery (T1), at 24h (T2), 48h (T3) and 72h (T4) after surgery. Reverse-phase high-performance liquid chromatography with fluorescence was used to measure serum EAA concentrations. Results The serum concentrations of glutamic acid (Glu), asparagic acid (Asp) and glycine (Gly) were significantly higher at T2, T3 than at T0 (P＜0.05). The concentrations were significantly higher at T2 in group P than in group S (P＜0.05), and Glu concentrations was increased significantly at T3 (P＜0.05). But there was no significant difference in the Glu, Asp, Gly concentrations at T1 and T4 between the 2 groups (P＞0.05). Conclusions Anesthesia with propofol and remifentanil reduces the serum concentrations of EAA for the elderly undergoing off-pump coronary artery bypass, and thus protect them from postoperative cognitive dysfunction.