全身麻醉对单纯鼾症患者术后认知功能的影响

doi:10.6040/j.issn.1673-3770.0.2017.187

摘要/Abstract

摘要： 目的通过评估单纯鼾症患者全身麻醉(全麻)手术前后血清S100β蛋白、血清神经元特异性烯醇化酶(NSE)的相关性,探讨全麻对该类患者手术前后认知功能的影响。方法择期全麻关节镜检查术,单纯鼾症(AHI<5)及睡眠正常患者各30例,术前、术后通过蒙特利尔认知功能量表(Montreal cognitive assessment, Mo CA)评估认知功能,分析两组血清S100β、NSE的变化趋势。结果与术前比,两组血清S100β及NSE在术毕及术后6 h、12 h升高(P<0.05)。与正常组比,鼾症组Mo CA评分差异无统计学意义(P>0.05),但血清S100β在术前、术毕、术后6 h有差异,NSE在术毕及术后6 h、12 h升高(P<0.05)。结论单纯鼾症患者全麻术后出现认知功能受损,但认知功能受损程度仅在血清学指标上有所改变。

关键词: 单纯鼾症, 认知功能, S100β蛋白, NSE, 全身麻醉

Abstract: Objective To assess the correlation between serum S100β protein and serum neuron-specific enolase(NSE)levels before and after general anesthesia in patients with simple snoring(SS)and investigate the effect of general anesthesia on the cognitive function of these patients before and after an operation. Methods Patients undergoing selective arthroscopy surgery under general anesthesia were divided into the SS(AHI<5, n1=30)and normal sleep(n2=30)groups. Pre- and post-operatively, the cognitive function was evaluated using the Montreal Cognitive Assessment(Mo CA)test and the changes in serum S100β and NSE levels were analyzed in the two groups. Results Compared to the preoperative levels, serum S100β and NSE levels in both groups significantly increased at the end of and 6 h and 12 h after surgery(P<0.05). Compared to that of the normal sleep group, there was no significant difference in the Mo CA scores in the SS group(P>0.05). However, levels of serum S100β were different preoperatively and at the end of and 6 h after surgery(P>0.05). NSE levels increased at the end of and 6 h and 12 h after surgery(P>0.05). Conclusion Patients with simple snoring after general anesthesia had impaired cognitive function, but the extent of cognitive impairment was was only reflected by serological changes.

Key words: General anesthesia, Cognitive function, S100β, Simple snoring, NSE

中图分类号:

R766.7

耿聪,张丽伟,丁明. 全身麻醉对单纯鼾症患者术后认知功能的影响[J]. 山东大学耳鼻喉眼学报, 2017, 31(5): 85-88.

GENG Cong, ZHANG Liwei, DING Ming. The effect of general anesthesia on postoperative cognitive function in patients with simple snoring.[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2017, 31(5): 85-88.

参考文献

[1] 刘艳骄. 睡眠医学介绍[J]. 世界睡眠医学杂志,2015(1):2-7. LIU Yanjiao. Sleep Medicine Introduction[J].World of Sleep Medicine, 2015(1):2-7.
[2] 谢宇平, 王金凤, 周丽雅. 睡眠医学中心的规范化建设[J]. 中国医学文摘(耳鼻咽喉科学), 2015(3):132-134.
[3] 李静, 殷敏, 程雷. 美国睡眠医学学会2016年版成人阻塞性睡眠呼吸暂停诊断指南解读[J]. 山东大学耳鼻喉眼学报, 2017,31(1):1-3. LI Jing, YIN Min, CHENG Lei. Interpretation of the clinical practice guidelines for diagnostic testing for adult obstructive sleep apnea: an update for 2016. An American Academy of Sleep Medicine Clinical Practice Guideline [J]. J Otolaryngol Ophthalmol Shandong Univ, 2017,31(1):1-3.
[4] Kim SJ, Lee JH, Lee DY, et al. Neurocognitive dysfunction associated with sleep quality and sleep apnea in patients with mild cognitive impairment[J].Am J Geriatr Psychiatry, 2011, 19(4):374-381.
[5] Twigg GL, Papaioannou I, Jackson M, er al. Obstructive sleep apneoe syndrome is associated with deficcits in verbal but not visual memory[J].Am J Respir Crit Care Med, 2010, 182(1): 98-103.
[6] 韩晓庆,张盼盼,王红阳,等. 不同程度低氧对阻塞性睡眠呼吸暂停低通气综合征患者认知功能及血清5-羟色胺水平的影响[J]. 现代预防医学,2015,42(15):2866-2868. HAN Xiaoqing, ZHANG Panpan, WANG Hongyang, et al.The influence of the degree of hypoxia on the cognitive function and level of serum 5-HT in the patients with OSAHS[J]. Modern Preventive Medicine, 2015, 42(15):2866-2868.
[7] 中华耳鼻咽喉头颈外科杂志编辑委员会,中华医学会耳鼻咽喉头颈外科学分会咽喉学组. 阻塞性睡眠呼吸暂停低通气综合征诊断和外科治疗指南[J]. 中华耳鼻咽喉头颈外科杂志, 2009, 44(2): 95-96. Editorial committee of Chin J Otorhinolaryngol Head Neck Surgery, Pharyngeal and laryngeal academic Group of branch of Otorhinolaryngology Head and Neck Surgery,Chinese medical association. Guidelines of obstructive sleep apnea hypopnea syndrom diagnosis and surgical treatment [J]. Chin J Otorhinolaryngol Head Neck Surgery, 2009, 44(2):95-96.
[8] 金振娅. 远离慢病从睡个好觉开始[N]. 光明日报,2017-03-21(006).
[9] 赵蕾, 黄席珍. 睡眠打鼾研究概况[J]. 中国全科医学, 2002, 5(5): 412.
[10] 刘建红, 梁大华, 韦彩周, 等. 广西地区打鼾人群血压状况分析[J]. 中华结核和呼吸杂志, 2007, 30(5): 347-351.
[11] Punjabi NM, Polotsky VY. Disorders of glucose metabolism in sleep apnea[J]. J Appl Physiol, 2005, 99(5): 1998-2007.
[12] 谭亚洲. 阻塞性睡眠呼吸暂停低通气综合征患者认知功能障碍及影响因素[D]. 芜湖:皖南医学院, 2015. TAN Yazhou. Cognitive impairment of patients with obstructive sleep apnea-hypopnea syndrome and its infuencing factors [D]. Wan Nan Med Coll, 2015.
[13] 周红梅,邓龙蛟,李水英,等. MoCA和MMSE在老年患者不同麻醉方式下肢骨科手术后认知功能评估中的应用比较[J]. 山东医药, 2016,56(16):57-59.
[14] Dalrymple-Alford JC, MacAskill MR, Nakas CT, et al. The Mo CA: well-suited screen for cognitive impairment in Parkinson disease[J]. Neurology, 2010, 75(19): 717-725.
[15] Damian AM, Jacobson SA, Hentz JG, et al. The montreal cognitive assessment and the mini-mental state examination as screening instruments for cognitive impairment: item analyses and threshold scores[J]. Dement Geriatr Cogn Disord, 2011, 31(2):126-131.
[16] Fujiwara Y, Suzuki H, Yasunaga M, et al. Brief screening tool for mild cognitive impairment in older Japanese: Validation of the Japanese version of the Montreal Cognitive Assessmen[J].Geriatr Gerontol Int, 2010, 10(3): 225-232.
[17] 于焰,张娜,娄毅,等. 蒙特利尔认知评估量表在老年认知功能评估中的应用[J]. 中华老年心脑血管病杂志,2011,13(4):295-298. YU Yan, ZHANG Na, LOU Yi, et al. Application of Montreal Cognitive Assessment to cognitive function evaluation in the old-elderly[J].Chin J Geriatr Heart Brain Vessel Dis, 2011, 13(4):295-298.
[18] Monk TG, Weldon BC, Garvan CW, et al. Predictors of cognitive dysfunction after major noncardiac surgery[J]. Anesthesiology, 2008, 108(1):18-30.
[19] van Munster BC, Korse CM, de Rooij SE, et al. Markers of cerebral damage during delirium in elderly patients with hip fracture[J]. BMC Neurol, 2009, 27(9):21.
[20] (·overl)van G, Özköse HZ. The effect of total intravenous anesthesia on the postoperative cognitive functions of young andelderly patients after lumbar disk surgery[J]. Turk J Med Sci, 2015, 45(1):191-196.
[21] Li YC, Xi CH, An YF, et al. Perioperative inflammatory response and protein S-100βconcentrations-relationship with post-operative cognitive dysfunction in elderly patients[J]. Acta Anaesthesiol Scand, 2012, 56(5):595-600.
[22] Jeon YT, Kim BG, Park YH, et al. Postoperative cognitive changes after total knee arthroplasty under regional anesthesia[J]. Medicine(Baltimore), 2016, 95(52):e5635.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed