丙泊酚对op-CABG患者认知功能及神经生长因子的影响

Effect of Propofol on cognitive function and nerve growth factor in op-CABG patients

摘要:

目的探讨不同丙泊酚靶控麻醉维持剂量对非体外循环下冠状动脉旁路移植术(op-CABG)患者术后认知功能障碍（POCD）及神经生长因子（NGF）表达水平的影响。方法选取2013 年5 月-2015 年4 月在该院实施co-CABG 术的105例患者，按照数字表法分成3 组，根据丙泊酚靶控麻醉剂量的不同分为高剂量组（丙泊酚>3.0 μg/ml）、中剂量组（丙泊酚2.5～3.0 μg/ml）、低剂量组（丙泊酚<2.5 μg/ml），每组35 例，比较3 组患者在手术时间、麻醉时间、POCD 发生率的差异，并对麻醉各时期3 组麻醉深度、血流动力学指标及NGF 表达水平进行比较。结果3 组患者在手术时间、麻醉时间比较，差异无统计学意义（P >0.05），但中、高剂量组POCD发生率分别为11.4%和5.7%，均低于低剂量组的31.4%（P <0.05）；中、高剂量组麻醉深度、平均动脉压比较差异无统计学意义（P >0.05），但两者数值低于低剂量组（P <0.05）；而3 组围手术期中心率变化比较，差异无统计学意义（P >0.05）；手术结束后，中、高剂量组患者NGF 表达水平也高于低剂量组（P <0.05）。结论2.5～3.0 μg/ml 丙泊酚靶控剂量维持麻醉可在获得满意麻醉深度的同时，减少药物对机体血流动力学的影响，并有利于降低POCD 的发生，促进NGF 的表达。

Abstract:

Objective To explore the effect of different maintenance dosages of Propofol target controlled anesthesia on postoperative cognitive dysfunction (POCD) and nerve growth factor (NGF) expression in the patients with off-pump coronary artery bypass grafting (op-CABG). Methods This study included 105 patients receiving op-CABG surgery in our hospital between May 2013 and April 2015. According to the random number table they were divided into three groups. According to the dosages of Propofol target controlled anesthesia they were divided into high-dose group (> 3.0 μg/ml), medium-dose group (2.5-3.0 μg/ml), and low-dose group (< 2.5 μg/ml), with 35 cases in each group. The surgical time, anesthesia time, and incidence of POCD were compared among the three groups. The depth of anesthesia, hemodynamic parameters, and nerve growth factor (NGF) level were also compared at different anesthetic stages. Results Among the three groups, the surgery time and anesthesia time were not significantly different (P > 0.05), but the POCD incidences in the medium-dose group and high-dose group were 11.4% and 5.7% respectively, which were significantly lower than 31.4% in the low-dose group (P < 0.05). In addition, the depth of anesthesia and mean arterial pressure were not significantly different between the medium-dose group and high-dose group, but both were lower than those in the low-dose group ( < 0.05). There were no statistical differences in the perioperative heart rate among the three groups (P > 0.05). After surgery, the NGF expression levels of the medium-dose and high-dose groups were significantly higher than that of the low-dose group (P < 0.05). Conclusions In Propofol target controlled anesthesia, the maintenance dosage of 2.5-3.0 μg/ml can induce satisfactory depth of anesthesia, meanwhile reduce the impact of drugs on the body's hemodynamics, and help to reduce the occurrence of POCD and promote the expression of NGF.