七氟醚和异丙酚复合麻醉对老年膝骨性关节炎患者术后血清NSE与S100B蛋白及认知功能的影响

目的探讨七氟醚和异丙酚复合麻醉对老年膝骨性关节炎(KOA)术后患者血清神经元特异性烯醇化酶(NSE)与S100B蛋白及认知功能影响。方法选取2015年1月~2016年12月老年KOA手术患者76例,随机分为七氟醚组与异丙酚组,分别予七氟醚和异丙酚复合麻醉。观察两组麻醉后6 h、24 h和72 h血清NSE与S100B蛋白及认知功能MMS评分变化。结果两组麻醉后6 h、24 h血清NSE与S100B蛋白均较麻醉前上升(P0.05或P0.01),且七氟醚组上升值更低(P0.05)。两组麻醉后72 h血清NSE与S100B蛋白恢复到与麻醉前比较相接近(P0.05);同时两组麻醉后6 h、24 h MMSE评分较麻醉前下降(P0.05或P0.01),且七氟醚组下降值更低(P0.05)。两组麻醉后72 h MMSE评分恢复到与麻醉前比较相接近(P0.05)。结论七氟醚和异丙酚复合麻醉均可影响老年KOA全麻后早期认知功能,前者早期对血清NSE与S100B蛋白的影响相对较小,可减少术后认知功能障(POCD)的发生。

Effects of combined anesthesia with sevoflurane and propofol on serum NSE, S100B protein and cognitive function in postoperative elderly patients with knee osteoarthritis

Objective To investigate the effect of combined anesthesia with sevoflurane and propofol on serum neuronspecific enolase(NSE), S100B protein and cognitive function in postoperative elderly patients with knee osteoarthritis (KOA). Methods A total of 76 elderly patients with KOA undergoing surgery from January 2015 to December 2016 were selected. They were randomly divided into sevoflurane group and propofol group, which were given sevoflurane and propofol combined anesthesia respectively. The changes of serum NSE, S100B protein and MMS score of cognitive function were observed at 6 h, 24 h and 72 h after anesthesia in both groups. Results Serum levels of NSE and S100B protein increased significantly at 6 h and 24 h after anesthesia in both groups compared with those before anesthesia(P<0.05 or P<0.01), with the increase of sevoflurane group a little lower(P<0.05). At 72 h after anesthesia, the serum level of NSE and S100B protein recovered to the similar level of those before anesthesia(P>0.05). The MMSE score at 6 h and 24 h after anesthesia decreased significantly in both groups(P<0.05 or P<0.01), where the sevoflurane group showed a lower decrease(P<0.05). The MMSE score at 72 h after anesthesia in both groups recovered to the similar level of those before anesthesia(P>0.05). Conclusion Both sevoflurane and propofol combined anesthesia can affect early cognitive function after general anesthesia in elderly patients with KOA, where the former showed relatively little effect on serum NSE and S100B protein, and can reduce the incidence of postoperative cognitive dysfunction(POCD).