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目的观察丙泊酚或依托咪酯麻醉对幼儿腹腔镜下疝修补术后早期认知功能及血浆谷氨酸(Glu)与γ-氨基丁酸(GABA)含量的改变,探讨血浆谷氨酸与γ-氨基丁酸水平变化与丙泊酚或依托咪酯麻醉后幼儿早期认知功能障碍的相关性。方法 100例1~3岁拟行择期腹腔镜下疝修补术患儿,随机分为丙泊酚麻醉组(A组)、依托咪酯麻醉组(B组)各50例;50例同年龄段健康幼儿作对照组(C组)。A、B组麻醉诱导分别给予丙泊酚1~3 mg·kg~(-1)、依托咪酯0.1~0.4 mg·kg~(-1)。比较A、B组内及组间术后认知功能障碍组和术后非认知功能障碍组患儿血浆谷氨酸、γ-氨基丁酸含量的变化。结果 A、B组术后3 d发生术后认知功能障碍的例数分别为10例(20.0%)、9例(18.0%,P>0.05)。与术前比较,A、B组出麻醉恢复室时非术后认知功能障碍组患儿血浆谷氨酸、γ-氨基丁酸含量略有升高,差异均无统计学意义(P>0.05),术后认知功能障碍组患儿血浆谷氨酸、γ-氨基丁酸含量均显著升高(P<0.05)。A、B组幼儿出麻醉恢复室时血浆谷氨酸、γ-氨基丁酸含量升高均,与其术后3 d发生术后认知功能障碍正相关(P<0.05)。结论血浆谷氨酸、γ-氨基丁酸含量可间接反映麻醉后幼儿发生不同程度的脑损伤,可作为幼儿术后早期发生术后认知功能障碍的检测指标。
Objective To observe the changes of early cognitive function and the content of glutamic acid (Glu) and γ-aminobutyric acid (GABA) in children with laparoscopic hernia repair after propofol or etomidate anesthesia, Changes of γ-Aminobutyric Acid Levels in Children with Early Cognitive Dysfunction after Propofol or Etomidate Anesthesia. Methods One hundred and 100 children aged 1 to 3 who underwent laparoscopic hernia repair were randomly divided into propofol anesthesia group (A group) and etomidate anesthesia group (B group), 50 patients each with the same age group Healthy children as a control group (C group). A group and B group were given propofol 1 ~ 3 mg · kg ~ (-1) and etomidate 0.1 ~ 0.4 mg · kg ~ (-1) respectively. The changes of plasma glutamate, γ-aminobutyric acid in children with cognitive impairment and postoperative non-cognition dysfunction were compared between groups A and B. Results The number of postoperative cognitive dysfunction occurred in group A and group B in 10 cases (20.0%) and in 9 cases (18.0%, P> 0.05), respectively. Compared with preoperative, the content of glutamate and γ-aminobutyric acid in non-postoperative cognitive dysfunction group was slightly increased in group A and group B when anesthesia recovery room was out of anesthesia recovery group, with no significant difference (P> 0.05 ), Postoperative cognitive dysfunction group of children with plasma glutamate, γ-aminobutyric acid were significantly increased (P <0.05). The levels of glutamate and γ-aminobutyric acid in the anesthesia recovery room of group A and B were both positively correlated with their postoperative cognitive dysfunction 3 days after operation (P <0.05). Conclusions The contents of glutamate and γ-aminobutyric acid in plasma may indirectly reflect different degrees of cerebral injury in young children after anesthesia, which may be used as a detection index of postoperative cognitive dysfunction in children.