尼卡地平复合艾司洛尔维持术中循环功能稳定对老年患者术后早期认知功能的影响  

Effects of Nicardipine combined with Esmolol to Maintain Stable Circulatory Function during Surgery for Elderly Patients on Early Postoperative Cognitive Function

作　　者：孙德峰[1] 杨林[2] 吴涛[1] 阎妮[1] 蔡晓[1] 

机构地区：[1]大连医科大学附属第一医院麻醉科,辽宁大连116011 [2]大连医科大学附属第一医院脑电图室,辽宁大连116011

出　　处：《中国医药指南》2012年第9期13-15,共3页Guide of China Medicine

摘　　要：目的观察尼卡地平复合艾司洛尔维持术中循环功能稳定对老年患者术后早期认知功能的影响。方法选择65岁以上患下肢动脉硬化闭塞症行人工血管旁路移植术患者76例。予以丙泊酚-芬太尼静脉麻醉复合局部浸润麻醉。随机均分为两组:尼卡地平复合艾司洛尔持续静脉泵注组(A组)及对照组(B组)。观察并记录各时间点之MAP、HR、SpO2及BIS值的变化。计算HR与SBP的乘积(RPP)、手术时间、术毕麻醉苏醒时间和术中芬太尼和丙泊酚的用药量。并在术前一天及术后第一天由本院同一心理医师采用神经心理学测试技术简易智力状态检查(MMSE)评定患者认知功能。结果术毕苏醒时间A组短于B组(P<0.05),芬太尼用药量A组低于B组(P<0.05);MMSE评分B组术后值明显低于术前,且术后值明显低于A组(P<0.05);B组术后1d有14例发生POCD,发病率36.8%,而A组术后1d有5例发生POCD,发病率13.2%,B组明显高于A组(P<0.05)。各时间点BIS值两组无显著性差异。结论尼卡地平复合艾司洛尔持续静脉泵注维持术中循环功能相对稳定,可在一定程度上降低老年患者术后早期认知功能障碍的发生率。Objective To observe the effect of nicardipine combined with esmolol to maintain stable circulation surgery for elderly patients on early postoperative cognitive function.Methods 76 LEAOD patients with vascular bypass grafting were randomly divided into two groups： continuous intravenous infusion of nicardipine combined with esmolol（group A） and control group（group B）.38 patients in each group.Mean arterial pressure（MAP）,heart rate（HR） and oxygen saturation（SpO2） and BIS were observed and recorded at the time point of 10 min before anesthesia（T0）,10 min（T1） and 1h（T2） after anesthesia and the end of surgery（T3）.The product of HR and SBP（RPP）,operative time,waking time and the dosage of propofol and fentanyl were calculated.The scores of MMSE were assessed in the preoperative and postoperative day by the same psychological doctor.Results The waking time and the dosage of fentanyl of group A were significantly lower than that of group B（P 0.05）.The scores of MMSE after operation was significantly lower than before operation in group B（P 0.05）.The scores of postoperative MMSE in group B was significantly lower than in group A（P 0.05）.The rates of POCD in groupAwas significantly lower than in group B（P 0.05）.BIS values at each time point was no significant difference between the two groups.Conclusions Continuous intravenous infusion of nicardipine combined with esmolol can maintain stable circulatory function and reduce the rates of early postoperative POCD for the olderly patients.

关 键 词：尼卡地平 下肢动脉硬化闭塞症/血管旁路移植术 循环功能 老年人 术后认知功能障碍 

分 类 号：R743[医药卫生—神经病学与精神病学]