丙泊酚和七氟醚麻醉对肝切除术患者术后认知功能及 Aβ-42 和 Tau 水平的影响。
Effect of propofol and sevoflurane anesthesia on postoperative cognitive function and levels of Aβ-42 and Tau in patients undergoing hepatectomy.
机构信息
Department of Anesthesiology, Jiangxi Provincial People's Hospital, Nanchang, P.R. China.
出版信息
Eur Rev Med Pharmacol Sci. 2019 Jan;23(2):849-856. doi: 10.26355/eurrev_201901_16900.
OBJECTIVE
To investigate the effect of propofol and sevoflurane anesthesia on postoperative cognitive function.
PATIENTS AND METHODS
Medical records of 280 patients who underwent hepatectomy in Jiangxi Provincial People's Hospital from April 2012 to July 2016 were retrospectively analyzed. Among those patients, 135 patients underwent propofol anesthesia (propofol group), and 145 patients under sevoflurane combined anesthesia (sevoflurane group). Hemodynamics was recorded 5 min before the induction of anesthesia (T0), after the induction of anesthesia (T1), at the beginning of the incision (T2), immediately after the incision (T3) and after the end of the surgery (T4). According to the Mini-Mental State Examination (MMSE), patients' cognitive function was evaluated before surgery. The levels of Aβ-42 and Tau proteins in the patient's serum were measured.
RESULTS
The stability of the mean arterial pressure after induction of anesthesia in the propofol group was higher than that of the sevoflurane group (p<0.05). MMSE scores in the propofol group were higher than those in the sevoflurane group (p<0.05). MMSE scores of patients in both groups 7 days after surgery were higher than those at 3 days after surgery (p<0.05). At 3 and 7 days after surgery, the levels of Aβ-42 in the propofol group were lower than those in the sevoflurane group (p<0.05) and the levels of Tau protein in the propofol group were higher than those in the sevoflurane group. The levels of Aβ-42 and Tau protein on the 3rd day after surgery in both groups were significantly higher than those before surgery (p<0.05). The Aβ-42 levels decreased at 7 days after surgery in both groups (p<0.05). The level of Tau protein on the 7th day after surgery was higher than that before surgery and 3 days after operation (p<0.05).
CONCLUSIONS
Compared with sevoflurane anesthesia, propofol may improve postoperative Aβ-42 and Tau protein levels in patients with hepatocellular carcinoma, and ameliorate postoperative cognitive function.
目的
研究丙泊酚和七氟醚麻醉对术后认知功能的影响。
患者和方法
回顾性分析 2012 年 4 月至 2016 年 7 月在江西省人民医院行肝切除术的 280 例患者的病历。其中丙泊酚麻醉 135 例（丙泊酚组），七氟醚复合麻醉 145 例（七氟醚组）。记录麻醉诱导前 5min（T0）、麻醉诱导后（T1）、切口开始时（T2）、切口即刻（T3）和手术结束时（T4）的血流动力学。根据简易精神状态检查表（MMSE）评估患者术前认知功能。测量患者血清 Aβ-42 和 Tau 蛋白水平。
结果
丙泊酚组麻醉诱导后平均动脉压的稳定性高于七氟醚组（p<0.05）。丙泊酚组 MMSE 评分高于七氟醚组（p<0.05）。两组患者术后 7 天 MMSE 评分均高于术后 3 天（p<0.05）。术后 3、7 天，丙泊酚组 Aβ-42 水平低于七氟醚组（p<0.05），丙泊酚组 Tau 蛋白水平高于七氟醚组。两组术后 3 天 Aβ-42 和 Tau 蛋白水平均明显高于术前（p<0.05）。两组术后第 7 天 Aβ-42 水平下降（p<0.05）。术后第 7 天 Tau 蛋白水平高于术前和术后第 3 天（p<0.05）。
结论
与七氟醚麻醉相比，丙泊酚可能改善肝癌患者术后 Aβ-42 和 Tau 蛋白水平，改善术后认知功能。
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