七氟醚预处理对非体外循环下冠状动脉旁路移植术患者术后早期认知功能的影响

目的评价七氟醚预处理对非体外循环下冠状动脉旁路移植术（off-pump coronary artery bypass, OPCABG）患者术后早期认知功能的影响。方法择期行OPCABG的患者60例，年龄55岁～75岁，ASA分级Ⅱ、Ⅲ级，采用随机数字表法分为两组（每组30例）：七氟醚预处理组（s组）和丙泊酚组（P组）。s组在手术开始时吸入1．0％～2．0％七氟醚，持续30min，维持同P组，其余麻醉措施两组相同。于麻醉诱导后即刻（T0）、关胸后（T1）、术后6h（T2）、术后12h（T3）、术后24h（T4）等5个时点采集颈内静脉球部血3ml，测定血清神经特异性烯醇化酶（neurone specific enolasc，NSE）、S100β蛋白、超氧化物歧化酶（superoxide dismutase，SOD）浓度。分别于术前1d和术后3d、7d、3个月对患者进行简易精神状态量表（min-mental stateexamination，MMSE）测验。结果与T0比较，两组患者于T1～B时血清S100β蛋白、NSE浓度显著增高（P〈0．05），而在T4时差异无统计学意义（P〉0．05）；S组患者血清SOD浓度在T1-T2时与T0时比较，差异无统计学意义（P〉0．05），而在T3-T4时显著增高（P〈0．05），P组患者血清SOD浓度在T1-T4时与T0时比较，差异无统计学意义（P〉0．05）。两组间比较，P组血清s100β蛋白、NSE浓度在T1-T2时显著高于s组（P〈0．05），而在T3～T4时比较，差异无统计学意义（P〉0．05）；两组间血清SOD浓度在T1-T2时比较，差异无统计学意义（P〉0．05），而在T3～T4时P组显著低于S组（P〈0．05）.S组术后3d、7dMMSE评分明显低于术前1d（P〈0．05），而术后3个月MMSE评分与术前1d比较，差异无统计学意义（P〉0．05）；P组患者术后3d、7d、3个月MMSE评分较术前1d均明显降低（P〈0．05）；两组间比较，s组患者术后3d、7d、3个月MMSE评分显著高于P组（P〈0．05），s组术后3d、7d、3个月术后认知功能障碍（postoperative cognitive dysfunction，POCD）的发生率明显低于P组（P〈0．05）.结论七氟醚预处理减轻OPCABG患者术后脑损伤程度，可预防和降低POCD的发生。

Effects of preconditioning with sevoflurane inhalation on postoperative cognitive function in patients undergoing off-pump coronary artery bypass grafting

Objective To investigate the effect of preconditioning with sevoflurane inhalation on postoperative cognitive function in patients undergoing off-pump coronary artery bypass grafting.Methods Sixty patients,aged 55～75,ASA Ⅱ or Ⅲ,who were scheduled for off-pump coronary artery bypass(OPCABG) were randomly divided into sevoflurane preconditioning group(group S) and propofol group (group P).1.0-自2.0％ sevoflurane were given to patients in group S at the beginning of operation and lasted for 30 min,and maintenance of anesthesia was same.Jugular bulb blood were harvested at 5 time points including anesthesia induction (T0),the end of operation (T1),6 h after operation (T2) and 12 h after operation (T3),24 h after operation (T4).Serum levels of S100β protein,neurone specific enolase (NSE) and superoxide dismutase (SOD) were detected respectively.Patients' cognitive function was evaluated by means of mini-mental state examination(MMSE) 1 d before surgery,and 3 d after surgery and 7 d after surgery,3 months after surgery.Results Compared with the T0,the serum concentrations of S100β protein and NSE increased significantly at T1 to T3 in two groups(P＜0.05),but there were no significant difference at T4 (P＞0.05).Compared with T0,the serum concentrations of SOD in group S were no significant difference at T1 and T2 (P＞0.05),but they were markedly higher at T3 and T4 (P＜0.05),the serum concentrations of SOD in group P were no significant difference at T1 to T4 (P＞0.05).Compared with the group S,the serum concentrations of S100β protein and NSE increased remarkably in group P at T1 and T2 (P＜0.05),but there were no significant difference at T3 and T4 (P＞0.05).Compared with the two groups,the serum concentrations of SOD were no significant difference at T1 and T2 (P＞0.05),but the serum concentrations of SOD in group S were remarkably higher than group P at T3 and T4 (P＜0.05).The MMSE values of group S at 3 d,7 d after surgery were significantly lower than that before operation (P＜0.05),but compared with the MMSE scores of preoperative,the values of MMSE showed no significant difference at 3 momths after surgery (P＞0.05).The MMSE values in group P at 3 d and 3 momths after surgery were significantly lower than that before operation(P＜0.05).The MMSE values of group S at 3 d,7 d,3 months after operation were significantly higher than that in group P (P＜0.05).The incidence of postoperative cognitive dysfunction(POCD)in group S were significantly lower than that in group P at 3 d,7 d,3 months after operation(P＜0.05).Conclusions Sevoflurane preconditioning can decrease incidence of POCD in patients undergoing OPCABG.