三种全身麻醉方法对老年患者腹腔镜胆囊切除术后认知功能的影响  

Effects of Three Methods of General Anesthesia on Postoperative Cognitive Function of Elderly Patients after Laparoscopic Cholecystectomy

作　　者：冯丽[1] 田玉科[1] 王鹏[1] 陈明兵[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院麻醉科,武汉430030

出　　处：《医药导报》2011年第1期49-54,共6页Herald of Medicine

摘　　要：目的比较咪达唑仑静脉复合、丙泊酚静脉复合麻醉、两者复合吸入异氟烷3种全身麻醉方法对老年患者术后认知功能的影响。方法 45例择期腹腔镜胆囊切除手术患者45例,随机分为3组,每组15例。A组咪达唑仑进行诱导,术中持续输注咪达唑仑维持麻醉;B组丙泊酚进行诱导,持续输注丙泊酚维持麻醉;C组咪达唑仑和丙泊酚进行诱导,同时输注咪达唑仑和丙泊酚并吸入异氟烷维持麻醉。术中持续监测心率(HR)、血压(BP)、脉搏血氧饱和度(SaO2)、听觉诱发电位指数(AAI),分别于术前、麻醉苏醒后恢复早期、中期、后期对各组患者进行认知功能测试并记录结果。结果①恢复早期:苏醒后5min时A组患者认知功能测试评分低于术前及B、C两组(P<0.05),15min时即恢复至术前水平。B、C两组患者在各时点(5,15,30min)测试评分与术前比较差异无显著性(P>0.05)。②恢复中期:苏醒后30min时3组患者认知功能测试评分均低于术前(P<0.05),A组下降最为明显(P<0.05),其次为B组、C组(P<0.05);1h时A、B两组患者测试评分均上升,两组比较差异有统计学意义(P<0.05),但仍低于术前水平(P<0.05),C组已恢复至术前水平;2h时B组认知功能恢复至术前水平,而A组仍低于术前水平(P<0.05)。③恢复后期:苏醒后4h时A、B两组患者认知功能测试评分均低于术前(P<0.05),A组下降较明显(P<0.05),C组与术前比较差异无显著性(P>0.05):24h时B组认知功能恢复至术前水平,而A组仍低于术前水平(P<0.05);苏醒后72h时,A组患者认知功能低于术前水平(P<0.05),B、C两组均与术前比较差异无显著性(P>0.05)。结论 3种全身麻醉方法对老年患者术后3d内的认知功能均有一定影响。其中咪达唑仑静脉复合麻醉的影响程度较大,持续时间也较长;丙泊酚静脉复合麻醉对认知功能的影响较小;采用咪达唑仑、丙泊酚静脉复合吸入异氟烷全身麻醉的老年患者认知功能恢复最�Objective To compare the effects of three general anesthesia methods including intravenous compound anesthesia with midazolam,propofol or two drugs combined with inhalation of isoflurane on postoperative cognitive function of elderly patients.Methods 45 ASA Ⅰ-Ⅱ patients aged 60-80 years undergoing laparoscopic operation were randomly assigned on three groups：group A（n=15）,midazolam was injected intravenously for anesthesia induction and midazolam-infusion was used in anesthesia maintenance;group B（n=15）,propofol was given in anesthesia induction and propofol-infusion was used during surgery for anesthesia maintenance;group C（n=15）,midazolam and propofol were given for anesthesia induction and during operation,and isoflurane was inhaled for anesthesia maintenance.The vital signs and AAI were monitored.The cognitive function tests were performed before surgery and at early recovery,medium recovery and late recovery after awakening.Results Early recovery：5 min after awakening,the scores of patients in group A were significantly lower than values of preoperative,group B and group C（P0.05）.But 15 min after awakening,group A returned to preoperative level.And there was no significant difference between other two groups at every time points（5,15,30 min）（P0.05）.Medium recovery：30 min after awakening,the scores decreased significantly in patients in three groups compared with preoperative values（P0.05）.Group A scored lowest（P0.05） and group B,group C by turns（P0.05）;1 h after awakening,the scores of group A and group B increased significantly and there was significantly difference between them（P0.05）,but they were all lower than preoperative values（P0.05）,at this time the scores of patients in group C returned to preoperative level.And so did group B at 2 h,yet the cognitive function level of group A was still lower than preoperative values（P0.05）.Late recovery：4 h after awakening,the scores of patients in group A and group B were both lower than preoperative val

关 键 词：咪达唑仑 丙泊酚 异氟烷 麻醉 全身 认知功能 

分 类 号：R971.2[医药卫生—药品] R604[医药卫生—药学]