【摘要】：目的探討輕度認(rèn)知功能障礙(mild cognitive impairment,MCI)老年患者腰椎減壓植骨融合術(shù)七氟醚復(fù)合丙泊酚的適宜配伍劑量,以保護(hù)其認(rèn)知功能。方法選擇擇期行腰椎減壓植骨融合術(shù)的患者80例,男41例,女39例,年齡65~75歲,BMI 17~26kg/m~2,ASAⅠ或Ⅱ級(jí),術(shù)前通過(guò)蒙特利爾量表(Montreal cognitive assessment,MoCA)、簡(jiǎn)易智力狀態(tài)量表(mini mental state examination,MMSE)、癡呆量表(dementia scale,CDR)和日常生活能力量表(daily living ability scale,ADL)評(píng)估認(rèn)定為輕度認(rèn)知功能障礙患者。采用隨機(jī)數(shù)字表法將患者分為四組:TCI丙泊酚2.0~2.5μg/ml組(P組)、TCI丙泊酚1.2μg/ml+七氟醚0.6 MAC組(PS1組)、TCI丙泊酚0.6μg/ml+七氟醚0.9MAC組(PS2組)和1.0~1.5MAC七氟醚組(S組)。在術(shù)前1d(T_0)、術(shù)后完全蘇醒(T_1)、3d(T_2)、7d(T_3)采用MMSE和MoCA量表評(píng)估患者認(rèn)知功能,采用ELISA法測(cè)定血漿載脂蛋白J(apolipoprotein J,ApoJ)濃度。結(jié)果與T_0時(shí)比較,T_1時(shí)四組MMSE和MoCA評(píng)分明顯降低(P0.05),T_2時(shí)S組MMSE和MoCA評(píng)分明顯降低(P0.05);與T_1時(shí)比較,T_2、T_3時(shí)四組MMSE和MoCA評(píng)分明顯升高(P0.05)。T_1~T_3時(shí)S組MMSE評(píng)分明顯低于P組、PS1組和PS2組(P0.05);T_2、T_3時(shí)S組MoCA評(píng)分明顯低于P組、PS1組和PS2組(P0.05)。與T_0時(shí)比較,T_1時(shí)四組血漿ApoJ濃度明顯升高(P0.05);與T_1時(shí)比較,T_2、T_3時(shí)四組血漿ApoJ濃度明顯降低(P0.05)。T_1~T_3時(shí)S組和PS2組血漿ApoJ濃度明顯高于PS1組(P0.05)。結(jié)論 MCI老年患者行腰椎減壓植骨融合術(shù)時(shí)TCI丙泊酚1.2μg/ml復(fù)合七氟醚0.6MAC對(duì)老年患者認(rèn)知功能影響較小,血漿ApoJ濃度較低。
[Abstract]:Objective to investigate the appropriate dosage of sevoflurane combined with propofol in lumbar decompression and bone graft fusion in elderly patients with mild cognitive impairment (mild cognitive impairment,MCI) in order to protect their cognitive function. Methods A total of 80 patients (41 males and 39 females, aged 65 to 75 years) undergoing lumbar decompression and bone graft fusion were enrolled in this study. The patients were divided into two groups: BMI 17 ~ 26kg 路m ~ (-1) / m ~ (2) ASA 鈪，

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