不同剂量氯胺酮静脉麻醉对乳腺区段切除术后早期认知功能的影响  

Effects of different doses of ketamine intravenous anesthesia on the earlycognitive function after segmental mastectomy

作　　者：李向前 邴艳春[1,2] 杨婉容 王鸿旻[1,2] 马静[1,2] LI Xiang-qian;BING Yan-chun;YANG Wan-rong;WANG Hong-min;MA Jing(Department of Anesthesiology,Gansu Provincial Cancer Hospital;Gansu Provincial Academic Institute of Medical Research,Lanzhou 730050,China)

机构地区：[1]甘肃省医学科学研究院 [2]甘肃省肿瘤医院麻醉科,730050

出　　处：《天津医药》2020年第4期289-293,共5页Tianjin Medical Journal

基　　金：甘肃省卫生行业科研计划管理项目(GWGL2014-34)。

摘　　要：目的探讨不同剂量的氯胺酮辅助全凭静脉麻醉对乳腺区段切除患者术后早期认知功能及疼痛的影响.方法选择我院择期在全凭静脉麻醉下行乳腺区段切除术的患者120例,随机分为4组(n=30),不使用氯胺酮的对照组(A组)和氯胺酮剂量分别给予0.5 mg/kg(B组)、1.0 mg/kg(C组)、1.5 mg/kg(D组)的观察组.记录4组患者麻醉诱导前(t0)、喉罩置入后(t1)、切皮后1 min(t2)和切皮后25 min(t3)各时间节点的平均动脉压(MAP)、心率(HR)的变化数值.随访记录术后2 h(T1)、6 h(T2)、12 h(T3)、24 h(T4)疼痛视觉模拟评分(VAS).分别采用简易智能精神状态检查量表(MMSE)和蒙特利尔认知评估量表(MoCA)两种评分方法评估术前1 d(T0),及术后2 h(T1)、6 h(T2)、12 h(T3)和24 h(T4)的认知功能.结果术中MAP、HR组内比较,B组各时间点变化最小、最稳定(P>0.05),A组各相邻时间点差值变化最大(均P<0.05).VAS评分B、C、D组T1~T3低于A组;B、C、D组间比较差异均无统计学意义(P>0.05).MMSE、MoCA评分比较,4组在T0和T4时间点差异均无统计学意义(P>0.05);T1时间点D组<C组<B组<A组(均P<0.05);T2时A组>B组>C组/D组(均P<0.05),T3时各组均较T2时评分明显上升(均P<0.05).结论氯胺酮可降低乳腺区段切除术后患者早期认知功能,且与剂量呈依赖性,但对术后24 h的认知功能无影响,小剂量的氯胺酮影响更小且术后镇痛效果好,术中生命体征更稳定.Objective To investigate the effects of different doses of ketamine-assisted total intravenous anesthesia on the early cognitive function and pain in patients undergoing segmental mastectomy.Methods A total of 120 patients undergoing elective segmental mastectomy under total intravenous anesthesia were selected and randomly divided into four groups(n=30),including the control group(groupA)without ketamine and the observation group given ketamine at 0.5 mg/kg(group B),1.0 mg/kg(group C)and 1.5 mg/kg(group D),respectively.The changes in mean arterial pressure(MAP)and heart rate(HR)of the four groups of patients were observed and recorded before anesthesia induction(t0),after laryngeal mask placement(t1),1 minute after skin incision(t2),and 25 minutes after skin incision(t3).The Visual Analogue Scale(VAS)was closely followed at 2 hours(T1),6 hours(T2),12 hours(T3)and 24 hours(T4)after surgery.The scoring methods of Mini Mental State Examination(MMSE)and Montreal Cognitive Assessment(MoCA)were used to evaluate the early postoperative cognitive dysfunction(POCD)1 day(T0)before surgery,and 2 hours(T1),6 hours(T2),12 hours(T3)and 24 hours(T4)after surgery.Results The changes of MAP and HR in each time point during the operation were the smallest and stable in the group B(P>0.05),and the different value of adjacent time point was the largest in group A(P<0.05).The VAS scores of T1-T3 were lower in group B,C and D than those in group A(P<0.05),and there was no significant difference between groups B,C and D(P>0.05).There were no significant differences in MMSE and MoCA scores at T0 and T4 time points between the four groups(P>0.05).T1 time point was significantly lower in group D<group C<group B<group A(P<0.05).T2 time point was group A>group B>group C and D(P<0.05).The scores of T3 time points were significantly higher than those of T2(P<0.05).Conclusion Ketamine can reduce the early cognitive function in patients after segmental mastectomy with dose dependent manner,but no effect on the cognitive function 24 hours after

关 键 词：氯胺酮 麻醉 静脉 镇痛 认知功能障碍 乳腺区段切除 

分 类 号：R614[医药卫生—麻醉学]