不同全麻方式对缺血性脑血管病患者介入术后早期认知功能的影响  

Effects of two methods of general anesthesia on early postoperative cognitive dysfunction in patients with ischemic cerebrovascular disease

作　　者：刘帆[1] 李永旺[2] 马玉恒[2] 刘中光 

机构地区：[1]辽宁医学院中国人民解放军第二炮兵总医院研究生培养基地,北京100088 [2]中国人民解放军第二炮兵总医院麻醉科,北京100088

出　　处：《暨南大学学报（自然科学与医学版）》2016年第1期70-73,共4页Journal of Jinan University(Natural Science & Medicine Edition)

基　　金：北京市自然科学基金资助项目(7142169)

摘　　要：目的：探讨不同全身麻醉方法对缺血性脑血管疾病神经介入手术患者术后认知功能的影响.方法：选择择期在全麻下行神经介入手术的缺血性脑血管疾病患者80例,年龄≥60岁,美国麻醉医师协会（ASA）Ⅰ~Ⅲ级,随机分为丙泊酚组（P组,丙泊酚复合瑞芬太尼）和七氟烷组（S组,七氟醚复合瑞芬太尼）各40例.围术期采用FORE-SIGHT脑氧饱和度监测仪持续监测患者的脑氧饱和度（SctO2）,分别于术前1d、术后6h、术后24h采用简易智能状态检查量表（Mini-Mental State Exam,MMSE）评价患者的认知功能,并采血检测炎症因子（TNF-α、IL-1β、IL-6）的变化.记录患者术中血管活性药物使用量、术中体动以及苏醒期情况.结果：S组患者苏醒情况优于P组,围术期血管活性药物使用量更少,SctO2下降的相对值更小,术后6h认知功能障碍的发生率更低;两组患者不同时间点炎症因子的表达以及术中体动、苏醒期躁动情况差异无统计学意义.结论：神经介入手术患者采用七氟烷维持麻醉,围术期能更好的维持脑氧饱和度,术后清醒更快,术后早期认知功能障碍的发生率更低.Aim：To investigate the effects of two methods of general anesthesia on early postoperative cognitive dysfunction（POCD） in patients with ischemic cerebrovascular disease. Methods： Eighty pa- tients（ ≥60 years old, ASA Ⅰ - Ⅲ） with ischemic cerebrovascular disease who underwent interventional neurosurgery were allocated randomly into two groups. The propofol group （group P） received propofol and remifentanil, and the sevoflurane group （group S） received sevoflurane and remifentanil after intuba- tion. To monitor of standard clinical parameters and absolute oximetry （ SctO2 ）. The Mini-Mental State Exam （MMSE） test was used to assess cognitive function before operation, 6 and 24 h after operation and the levels of TNF-α,IL-1 β,IL-6 were detected at the same time. The recovery times, the amount of phe- nylephrine, the number of patients with movement or emergence agitation were recorded. Results： Thegroup S had a more rapid recovery to spontaneous ventilation, eye opening, extubation and orientation compared with group P. In the group P, greater amount phenylephrine was used, but the number of pa- tients with movement or emergence agitation were similar. Early postoperative cognitive dysfunction was significantly lower with sevoflurane compared with propofol 6 hours after the surgery. The relative SctO2 maximum decrease of group P was more than group S. Conclusion： The use of sevoflurane in maintaining anesthesia during the interventional nuroradiology procedures was associated with the faster recovery, better preserved SctO2 and reduced early cognitive dysfunction compared with propofol.

关 键 词：七氟烷 丙泊酚 术后认知功能障碍 缺血性脑血管病 脑氧饱和度 

分 类 号：R614.2[医药卫生—麻醉学]