不同麻醉深度对老年患者术后认知功能和血清S100β蛋白水平的影响

Effect of different depths of anesthesia on postoperative cognitive function and serum S100β level in the elderly

摘要:

目的 研究和分析老年患者不同时间点血清S100β蛋白的浓度以及术后的认知功能与麻醉深度的关系。方法 选取2014年1月至2014年12月在湖北省荆门市第二人民医院全身麻醉下进行腹部手术的患者102例，根据脑电双频指数（BIS），分为浅麻醉组（30＜BIS＜45）和深麻醉组（BIS≥45），每组51例。检测两组患者的心率（HR）、麻醉深度指数（NTI）、平均动脉压（MAP）、血清S100β蛋白的浓度等指标，并使用简易精神状态检查表（MMSE）、画钟测验（CDT）和动物流畅性测验(AFT)评测两组患者是否发生术后认知功能障碍（POCD）。结果 深麻醉组患者的丙泊酚用量显著高于浅麻醉组（P＜0.01）。两组的POCD发生率分别为13.7%和47.1%，差异有统计学意义（χ2＝3.996，P＜0.05)。与浅麻醉组患者相比较，深麻醉组患者在术毕、术后2h和术后24h时间点的血清S100β蛋白浓度显著降低，差异具有统计学意义（P＜0.05）。结论 不同麻醉深度的术后疼痛程度和麻醉效果基本相同，且均损及老年患者的中枢神经系统，但从各观察点的血清S100β蛋白的浓度来看，麻醉深度较浅的老年患者神经系统损伤程度更严重。提示在手术中维持深度麻醉可以降低患者POCD的发生率。

Abstract:

Objective To determine the serum levels of protein S100β at different time points and cognitive function postoperatively, and investigate their relationship with depth of anesthesia. Methods A total of 102 elderly patients, at American Society of Anesthesiologists (ASA) grade of Ⅱ-Ⅲ, undergoing abdomen surgical treatment with general anesthesia in our hospital from January 2014 to December 2014 were enrolled in this study. According to their bispectral index (BIS), they were divided into the deep anesthesia group (BIS≥45) and light anesthesia group (30＜BIS＜45), with 51 cases in each group. Heart rate (HR), narcotrend index (NTI), mean artery pressure (MAP), and serum S100β level were measured and recorded. Minimental state examination (MMSE), clock drawing test (CDT), and animal fluency test (AFT) were used to assess the occurrence of postoperative cognitive dysfunction (POCD). Results The deep anesthesia group had a obviously higher dose of propofol than the light anesthesia group (P＜0.01). The incidence of POCD was 13.7% in the deep anesthesia group, and 47.1% in the light anesthesia group, with significant difference between them (Chi square＝3.996, P＜0.05). At the time point of finishing operation, the 2nd hour and the 24th hour after operation, the serum levels of S100β were markedly lower in the deep anesthesia group than in the light anesthesia group (P＜0.05). Conclusion Different depths of anesthesia lead to same postoperative pain levels and exert similar anesthesia effect, and both cause nervous system damage. The postoperative serum levels of S100β indicate that the light anesthesia group results in more severe nervous system damage, suggesting that maintaining deep anesthesia reduce the occurrence of POCD.