不同麻醉方式对老年心脏手术患者术后认知功能障碍的影响  

The effect between different methods of anesthesia on the postoperative cognitive dysfunction of elderly patients with cardiosurgery

作　　者：庞小翼[1] 张培根[2] 杨明[1] 赵径[1] 

机构地区：[1]川北医学院附属第二医院四川绵阳四〇四医院麻醉科,四川绵阳621000 [2]川北医学院附属第二医院四川绵阳四〇四医院骨科,四川绵阳621000

出　　处：《实用临床医药杂志》2014年第E02期19-21,共3页Journal of Clinical Medicine in Practice

基　　金：绵阳市卫生局课题（201240）

摘　　要：目的探讨不同麻醉方式对老年心脏病患者术后认知功能障碍（POCD）的影响。方法选取拟接受心脏手术的患者87例，按随机数字表法分为A、B、C组，各29例，A组：全凭静脉麻醉，全麻诱导后，采用丙？自酚、维库溴铵、舒芬太尼维持麻醉；B组：全凭吸入麻醉，患者全麻诱导后，采用七氟醚、维库溴铵、舒芬太尼维持麻醉；C组：静吸复合麻醉，患者全麻诱导后，采用丙泊酚、七氟醚、维库溴铵、舒芬太尼维持麻醉。分别于术前24h，术后24h、72h、7d应用简易精神状态量表（MMSE）进行神经功能评价，并观察POCD及苏醒期谵妄的发生率。结果3组患者术后MMSE评分均显著降低（P〈0．05，P〈0．01），在术后72h时降至最低，随后逐渐恢复。其中C组在术后72h、120h、7d时MMSE评分均显著高于A组（P〈0．05，P〈0．01）。C组患者术后POCD发生率及术后72h、120h苏醒期谵妄发生率显著低于A、B组（P〈0．05）。结论对老年心脏病手术患者采取丙泊酚、七氟醚、维库溴铵和舒芬太尼四种药物联合麻醉，显著减少POCD发生率，值得推广和应用。Objective To observe the influence of different methods of anesthesia on the postoperative cognitive dysfunction of elderly patients with cardiosurgery. Methods A total of 87 patient undergoing cardiosurgery were randomly divided into three groups （ A, B and C） , with 29 cases in each group. Group A （ total intravenous anesthesia） were taken propofol, sufentanil and vecuronium to maintain anesthesia after induction of general anesthesia. Group B （inhalation anesthesia group） were given sevoflurane, vecuronium and sufentanil combined anesthesia after routine anesthesia induction. Group C （intravenous inhalation combined anesthesia） received propofol, sevoflurane, vecuroni- um and sufentanil anesthesia straightly after induction of general anesthesia. The nerve function of patients was assessed by Mini-Mental State Examination （MMSE） 24 hours before operation, 24 hours, 72 hours and 7 days after operation. The incidence of postoperative cognitive dysfunction （POCD） and delirium in recovery period were observed as secondary outcomes. Results The score of MMSE were decreased after operation in all three groups, a （ P 〈 0. 05, P 〈 0.01 ）, with the lowest value at 72 hours after surgery. The MMSE score were higher in group C than those in group A at 72 hours and 7 days after operation （ P 〈 0. 05, P 〈 0. 01 ）. The incidence of POCD and delirium in recovery period were lower in group C than those in Group A and group B. Conclusion Taking propofol, sevoflurane, vecuronium and sufentanil combined anesthesia can reduce the incidence of POCD in elderly patients with cardiosurgery.

关 键 词：心脏手术 全身麻醉 手术后认知功能障碍 苏醒期谵妄 

分 类 号：R614.2[医药卫生—麻醉学]