血必净对中度贫血女性患者术后早期认知功能障碍的影响

目的:观察血必净注射液对中度贫血女性患者术后认知功能障碍(Postoperative Cognitive Function,POCD)的发生率的影响,并探讨其可能机制。方法:选取我院腹腔镜下子宫肌瘤剔除术或全子宫切除术的女性患者160例,随机分成中度贫血组(C组,80例)和血必净治疗组(X组,80例)。所有患者均采用相同的麻醉和复苏方案。其中,X组于麻醉诱导前及送麻醉复苏室(Postanesthesia Care Unit,PACU)后给予血必净注射液100 mL静脉滴注,C组给予同等体积的生理盐水静脉滴注。分析各组患者术前、术后1 d、7 d的蒙特利尔认知测试(Montreal Cognitive Assessment,MoCA)评分差异,计算POCD发生率,比较其术前及术后1 d的血清S-100β和IL-6水平变化。结果:各组患者一般情况以及术前MoCA评分均无明显差异。术后第1 d和第7 d,与C组相比,X组患者POCD发生率较低(P<0.05)。两组术前血清S-100β和IL-6水平均无差异。术后1 d,两组患者血清S-100β和IL-6水平均较术前升高。与C组相比,X组术后1 d血清S-100β和IL-6水平降低。结论:血必净注射液可通过调控术中炎症水平,减轻中枢神经损伤,降低中度贫血女性患者POCD发生率。     

右美托咪定对老年患者全麻术后认知功能障碍的Meta分析

目的：采用循证医学的方法系统评价右美托咪定在老年患者全麻术后认知功能障碍的影响。方法计算机检索Cochrane、PubMed、Medline、知网、维普、万方数据库,均从建库到2015年7月发表的文献,对符合纳入与排除标准的研究进行资料提取,并采用RevMan 5.2软件进行Meta分析。结果最终纳入13个随机对照试验,共计854例患者。Meta分析结果显示：术后1 d右美托咪定组简易精神状态评价量表(MMSE评分)高于对照组,差异有统计学意义(P<0.05);右美托咪定组术后1 d POCD的发生率明显低于对照组(P<0.05),差异有统计学意义。结论老年患者全麻术中使用右美托咪定,能有效改善患者术后认知功能障碍,降低POCD的发生率。     

自噬在丙泊酚麻醉致老年大鼠术后认知功能障碍中的作用

目的 探讨丙泊酚麻醉对老年大鼠术后认知功能的影响及自噬在其中的作用。方法 将老年大鼠72只,随机分为4组：对照组、丙泊酚组、雷帕霉素组、丙泊酚+雷帕霉素组。雷帕霉素组及丙泊酚+雷帕霉素组于麻醉前5 d ip雷帕霉素10 mg/kg,每天1次,麻醉当日为麻醉前1 h注射,共6 d。丙泊酚组及丙泊酚+雷帕霉素组以20 mg/kg丙泊酚诱导麻醉,并以54 mg/kg/h维持4 h。采用Morris水迷宫评测大鼠学习与记忆功能;Western Blotting技术及免疫荧光观察麻醉后24 h、6 d海马区自噬相关蛋白的表达。结果 与对照组比较,丙泊酚组第1~3天逃避潜伏期显著延长（P<0.05、0.01）,目标象限探索时间明显缩短,穿平台次数明显减少（P<0.05）;麻醉后24 h、6 d海马区自噬相关蛋白LC3B、Beclin-1蛋白表达明显减少,p62蛋白表达明显增多（P<0.05）。与丙泊酚组比较,丙泊酚+雷帕霉素组第1~3天逃避潜伏期缩短,目标象限探索时间显著延长,穿平台次数明显增加（P<0.05）;麻醉后24 h、6 d海马区自噬相关蛋白LC3B、Beclin-1表达明显增多,p62表达明显减少（P<0.05）。结论 丙泊酚连续麻醉4 h可导致老年大鼠空间学习记忆能力损伤,其机制可能与抑制海马区自噬有关。     

全麻与全身-硬膜外复合麻醉对老年非心脏手术患者术后早期认知功能的影响

目的探讨不同麻醉方法对老年非心脏手术患者术后早期认知功能的影响。方法选择老年非心脏手术患者89例的临床资料进行回顾性分析。其中47例采用全麻进行手术,42例采用全身-硬膜外复合麻醉手术。分别对患者术前1天、术后7天的神经精神功能进行检测,判断不同麻醉方法对患者早期认知功能的影响。结果两组术前神经精神功能评分比较均无显著性差异,两组间术后比较也无显著性差异（P〉0.05）。两组术后神经精神功能恶化情况比较差异无统计学意义（P〉0.05）。结论全麻与全身-硬膜外复合麻醉对老年非心脏手术患者术后早期认知功能影响无显著性差异。     

Effects of different concentration and duration time of isoflurane on acute and long-term neurocognitve function of young adult C57BL/6 mouse

Postoperative cognitive dysfunction (POCD) is a decline in cognitive performance after a surgery with anaesthesia. The exact reasons of surgery and/or anaesthesia resulting in POCD are unclear. The aim of this study is to investigate the effects of different concentration and duration time of isoflurane anaesthesia on cognitive performance and cellular mechanisms involved in learning and memory function. In present work, young adult male C57BL/6 mice (age: 8 weeks) were anaesthetized by different concentration isoflurane in 100% oxygen for different duration time (Mice in group I₁ received 0.7% isoflurane 0.5 h, mice in I₂ received 0.7% isoflurane 2 h, mice in I₃ received 1.4% isoflurane 2 h, and mice in I₄ received 1.4% isoflurane 4 h). Non-anaesthetized mice served as control group (I₀). Spatial learning was assessed at 10 days post-anesthesia in Morris water maze (MWM). Hippocampal protein expressions of activated caspase 3, NMDA receptor subunit NR2B, and extracellular-signal regulated kinase (ERK) 1/2 were evaluated 24 hours and 2 weeks post anesthesia. Protein expression of activated caspase3 was detected acute elevated in I₃ (24 h post-anesthesia) and acute and long-term elevated in I₄ (24 hours and 2 weeks post-anesthesia). There was no significant difference between I₁, I₂ and control group. Protein expressions of NR2B showed an acute and long-term increasement in I₁ and I₂, decreasement in I₄, and an acute decline, then returned to normal in I₃ compared to control group. The ratio of phosopho-ERK1/2 to total-ERK showed an acute increasement in I₁ and I₂, then came to normal 2 weeks post anesthesia compared to control group, meanwhile, we detected an acute and long-term decline in I₃ and I₄. In MWM test, mice in I₁ and I₂ showed cognitive improvement, mice in I₃ showed similar to control group, while mice in I₄ demonstrated cognitive impairment, which were approximately corresponding to the changes of protein expression of NR2B and activation of ERK1/2. The present data suggested the following: (1) Isoflurane may cause neurotoxicity by inducing caspase activation and apoptosis with the anesthetic concentration increased and duration prolonged. (2) Low concentration of isoflurane in 2 hours can induce a hippocampus-specific elevation of NR2B subunit composition and ratio of p-ERK1/2 to total ERK1/2, produce hippocampal-dependent cognitive improvement. While high concentration of isoflurane exceeding 4 hours may induce a decline of NR2B and ratio of pERK1/2 to ERK1/2, then result in cognitive impairment.     

针刺对全身麻醉后相关并发症的治疗和预防作用

分析了针刺对全身麻醉后相关并发症的治疗作用,包括术后疼痛和术后恶心呕吐。术后认知功能障碍是最近研究较多的术后并发症之一,通过研究针刺在阿尔海默氏症治疗中的作用,进一步分析针刺在术后认知功能障碍中可能的预防作用。     

术后认知功能障碍的研究进展

术后认知功能障碍(postoperative congnitire dysfunction,POCD)是一种严重的术后并发症,高发于老年人和心脏手术,严重可降低术后生存质量,临床上一般难以准确预测和诊断.普遍认为POCD的诱发与年龄、麻醉方法、药物、心肺转流术、低氧因素等有关.其发病机制尚未明了,可能与中枢炎症、乙酰胆碱、β-淀粉样蛋白、ApoE基因有关.     

麻醉与术后认知功能障碍的研究进展

麻醉的目标不仅是保障患者术中的安全与稳定,还包括追求术后的最佳恢复。术后认知功能障碍作为麻醉术后的并发症,日益受到麻醉界的关注,本文就麻醉及与麻醉相关的病理生理变化与术后认知功能障碍的相关关系进行综述。     

Surgery-induced behavioral changes in aged rats

Elderly patients may experience impairments in cognition or mood following surgery. To study the development and underlying mechanisms of these postoperative behavioral changes, young (3 months) and aged (18–20 months) male rats were subjected to abdominal surgery followed by behavioral testing during a period of 6 weeks. Microglia activation (IBA-1) and neurogenesis (DCX) were immunohistochemically determined. In separate experiments, the effects of anesthesia and the cytokine response (IL-6) following surgery were evaluated.     

老年直肠癌患者轻度低温下IL-2、IL-10变化与术后早期认知功能相关性的研究

目的比较老年直肠癌患者术中轻度低温及正常体温下细胞因子IL-2、IL-10的变化与术后早期认知功能的变化是否具有相关性.方法 ASAⅠ-Ⅱ级拟行直肠癌手术老年患者40例,年龄65~83岁,随机均分为常温组(Ⅰ组)和轻度低温组(Ⅱ组).分别于麻醉前1 h(T1)、手术结束时(T2)及术后24 h(T3)用流式细胞仪检测细胞因子IL-2、IL-10;另于术前1 d(N1)、术后第1天(N2)及术后第3天(N3)用MMSE量表对患者进行神经精神功能测试并记录得分情况.结果与T1时比较,II组IL-2血浆浓度在T2、T3时明显降低(P<0.01);与T1、T2时比较,II组T3时IL-10浓度明显增高(P<0.01).与N1时比较,2组患者MMSE评分N2时下降(P<0.05),尤以Ⅱ组降低明显,组间比较有差异(P<0.05).N3时评分又逐渐升高,与N2比较有差异(P<0.05).T2、T3时II组IL-2与N2时的MMSE评分存在明显的正相关性(r=0.459,P<0.01)(r=0.550,P<0.01).结论术中轻度低温导致的IL-2降低与老年直肠癌患者术后早期MMSE评分降低存在正相关.