Objective To investigate the effects of target-controlled infusion (TCI) of etomidate for total intravenous anesthesia on postoperative cognitive function in elderly patients. Methods Sixty patients aged 65-80y with ASA I or II were scheduled for abdominal operation under total intravenous anesthesia; 30 patients were induced with etomidate and remifentanil (group E) and another 30 patients were induced with propofol and remifentanil (group P). Anesthesia in group E was maintained with TCI of etomidate 0.3-0.8μg/ml and remifentanil 2.5-4.0ng/ml, while in group P anesthesia was maintained with TCI of propofol 2.5-4.0μg/ml and remifentanil 2.5-4.0ng/ml. The levels of serum ACTH, cortisol, neuron-specific enolas (NSE)and S-100P protein were detected 5 min before operation, and 0, 12, 24, 48 h after operation. The postoperative cognitive dysfunc-tion(POCD) was evaluated within 1 week. Results Both groups had the stabilized hemodynamics. The plasma cortisoI concentrations were decreased more markedly in group E than in group P, and the plasma ACTH concentrations were increased more prominently in group E than in group P (P<0.05). Compared to group P, the plasma NSE and S-100P concentrations were significantly increased in group E (P<0.05). The incidence of POCD was significantly increased in group E than in group P within 1 week (P<0.05). Conclusion Etomidate has an inhibition on the function of the adrenal cortex persistently in elderly patients,and then the postoperative cognitive function would be impaired.%目的 观察靶控输注依托咪酯用于老年患者全凭静脉麻醉对其术后认知功能的影响.方法 选择全麻下行择期手术的老年患者60 例,年龄65~80 岁;ASAⅠ或Ⅱ级.随机分为两组:依托咪酯组(E 组,n=30)和丙泊酚组(P组,n=30),E 组麻醉诱导采用靶控输注(TCI)依托咪酯和瑞芬太尼,P 组麻醉诱导采用TCI 丙泊酚和瑞芬太尼.E 组TCI 依托咪酯0.3~0.8滋g/ml和瑞芬太尼2.5~4.0滋g/ml 维持麻醉;P组TCI 丙泊酚2.0~4.0滋g/ml 和瑞芬太尼2.5~4.0ng/ml 维持麻醉.分别于麻醉诱导前5min、手术结束时、术后12、24、48h 抽取静脉血测定血浆促肾上腺皮质激素(ACTH)、皮质醇、神经元特异性烯醇化酶(NSE)和S-100β蛋白浓度.评估患者术后认知功能障碍(POCD)发生情况.结果 两组患者血流动力学稳定.与P 组相比,术后E组皮质醇浓度明显降低,ACTH浓度明显升高(P＜0.05);血浆NSE、S-100β蛋白浓度均显著增加(P＜0.05).术后1 周POCD 的发生率E 组较P 组也显著增加,差异有统计学意义(P＜0.05).结论 TCI 依托咪酯全身麻醉对老年患者肾上腺皮质功能产生持久的抑制,进而对老年患者的术后认知功能产生损伤.依托咪酯用于全身麻醉维持可能是导致老年人POCD 的一个危险因素.
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