神经介入手术患者术后早期认知功能障碍与脑氧饱和度的关系  

Relationships between cerebral oxygen saturation and early postoperative cognitive dysfunction in patients undergoing interventional neuroradiology treatment

作　　者：刘帆[1] 刘中光 李永旺[1] 马玉恒[1] 

机构地区：[1]中国人民解放军火箭军总医院麻醉科,北京100088

出　　处：《上海医学》2016年第6期363-367,共5页Shanghai Medical Journal

基　　金：北京市自然科学基金资助项目(7142169)

摘　　要：目的基于脑氧饱和度(S_(ct)O_2)监测,比较不同全身麻醉维持方式对神经介入手术患者术后早期认知功能的影响,并探索S_(ct)O_2与术后早期认知功能障碍间的关系。方法择期拟在全身麻醉下行神经介入手术治疗的基底动脉狭窄男性患者40例,根据麻醉维持期使用药物的不同,将患者分入丙泊酚组(丙泊酚复合瑞芬太尼)和七氟烷组(七氟烷复合瑞芬太尼)。术中连续监测患者的S_(ct)O_2和生命体征。分别于术前1d(基础值)、术后6h、术后24h,采用简易精神状态检查量表(MMSE)评估认知功能,将MMSE评分较基础值下降>2分定义为术后认知功能障碍(POCD)。△MMSE1和△MMSE2分别表示术后6和24h患者MMSE评分的变化。记录术中血管活性药物的使用剂量,术中发生体动、术后躁动的患者例数,以及患者的苏醒质量。采用线性相关性分析检验△MMSE1与S_(ct)O_2相对下降最大值和POCD患者相应S_(ct)O_2水平持续时间的相关性。结果两组间患者的年龄、BMI、美国麻醉医师协会(ASA)分级构成、手术时间和麻醉时间的差异均无统计学意义(P值均>0.05),但丙泊酚组的去氧肾上腺素和阿托品使用剂量均显著高于七氟烷组(P值均<0.05)。丙泊酚组麻醉苏醒期的自主呼吸时间、睁眼时间、拔除气管导管时间和定向力恢复时间均显著长于七氟烷组(P值均<0.05),S_(ct)O_2下降相对最大值和术后6h的POCD发生率均显著高于七氟烷组(P值均<0.05)。两组间术中体动、苏醒期躁动和术后24hPOCD的发生率,围术期平均和最低S_(ct)O_2,以及在麻醉诱导期间各时间点的S_(ct)O_2的差异均无统计学意义(P值均>0.05)。术后6h,两组中共8例(20%)发生POCD,其S_(ct)O_2为55%~65%。S_(ct)O_2下降相对最大值与△MMSE1无线性相关关系(r^2=0.06,P>0.05),S_(ct)O_2为55%~65%的暴露时间与△MMSE1呈直线相关(r^2=0.91,P<0.05)。结论在神经介入手术中,患者术后早期认知功能障碍的发生Objective To investigate the influence of anesthesia maintenance with propofol or sevoflurane on the incidence of postoperative cognitive dysfunction （POCD） based on the cerebral oxygen saturation （SctO2） monitoring in patients undergoing interventional n＇euroradiology treatment. Methods Forty male patients with stenosis of basilar artery treated by interventional neuroradiology procedures were divided into two groups： propofol and remifentanil were used in propofol group, and sevoflurane and remifentanil were used in sevoflurane group after intubation. The cerebral oxygen saturation monitoring was established and vital signs were recorded. The Mini-Mental State Exam （MMSE） test was used to assess cognitive function before operation and at 6 and 24 hours after operation. POCD was defined as the MMSE score decreased by more than 2 points compared with the basic value. △MMSE1 and △MMSE2 represented the changes of the MMSE score of the patients at 6 and 24 hours after the surgery. The recovery time, the amount of phenylephrine, the number of patients with movement or emergence agitation were recorded. Linear correlation analysis was used to test the correlation between the △MMSE1 and relative SctO2 maximum decrease and the correlation between POCD and the exposure time of the relative SctO2 maximum decrease. Results There were no significant differences in the age, body mass index （BMI）, American Society of Anesthesiologists （ASA） classification, operation time or anesthesia time between the two groups （all P〉0. 05）. The dosages of epinephrine and atropine of propofol group were significantly greater than those of sevoflurane group （both P 〈 0.05）. The sevoflurane group had a faster recovery to spontaneous ventilation, earlier eye opening, extubation and orientation, a lower relativeSctO2 maximum decrease and lower incidence of POCD at 6 hours after the surgery than propofol group （all P〈0. 05）. The number of patients with movement or emergence agitation, the incidence

关 键 词：七氟烷 丙泊酚 术后认知功能障碍 脑氧饱和度 神经介入手术 

分 类 号：R614.2[医药卫生—麻醉学]