七氟烷吸入麻醉对心脏瓣膜置换术后神经认知恢复延迟患者康复的影响  

Effect of sevoflurane inhalation anesthesia on rehabilitation of patients with delayed neurocognitive recovery after cardiac valve replacement surgery

作　　者：廖远强[1] 赵云陶 谢明祥 LIAO Yuanqiang;ZHAO Yuntao;XIE Mingxiang(Department of Anesthesiology,Mianyang Municipal Third People′s Hospital/Sichuan Provincial Mental Health Center,Mianyang,Sichuan 621000,China;Department of Anesthesiology,Youxian District Hospital of Traditional Chinese Medicine,Mianyang,Sichuan 621000,China)

机构地区：[1]四川省绵阳市第三人民医院/四川省精神卫生中心麻醉科,621000 [2]四川省绵阳市游仙区中医医院麻醉科,621000

出　　处：《重庆医学》2021年第8期1314-1317,共4页Chongqing medicine

基　　金：四川省科技支撑计划项目(2013FZ0051)。

摘　　要：目的研究七氟烷吸入麻醉对心脏瓣膜置换术后神经认知恢复延迟患者康复的影响。方法选取2018年3月至2020年1月绵阳市第三人民医院收治的行心脏瓣膜置换术患者76例,采用随机数字表法分为观察组和对照组各38例。对照组患者予全身麻醉,观察组患者于主动脉开放前吸入1.5~2.0 MAC七氟烷,维持麻醉方式同对照组。比较两组患者手术时间、体外循环时间、术中出血量及麻醉时间,气管拔管时间、重症监护病房(ICU)停留时间、院内病死率及术后1周认知功能障碍发生率,术前及术后6 h、1 d、3 d简易精神状态检查量表(MMSE)评分,血清S-100β蛋白、神经元特异性烯醇化酶(NSE)水平。结果两组手术时间、体外循环时间、术中出血量及麻醉时间比较差异均无统计学意义(P>0.05);观察组术后气管拔管时间、ICU停留时间明显短于对照组(P<0.05),两组病死率和认知功能障碍发生率比较差异无统计学意义(P>0.05);术前,两组MMSE评分比较差异无统计学意义(P>0.05),术后6 h两组MMSE评分与术前比较明显下降(P<0.05),术后1、3 d两组MMSE评分较术后6 h明显上升,且观察组MMSE评分明显高于对照组(P<0.05);两组术前S-100β蛋白和NSE水平比较差异无统计学意义(P>0.05),术后两组S-100β蛋白和NSE水平与术前比较明显上升(P<0.05),术后观察组S-100β蛋白和NSE水平明显低于对照组(P<0.05)。结论七氟烷吸入麻醉对心脏瓣膜置换术后神经认知恢复有显著效果,能有效促进患者认知功能恢复,降低近期认知功能障碍发生率。Objective To investigate the effect of sevoflurane inhalation anesthesia on the rehabilitation of the patients with delayed neurocognitive recovery after cardiac valve replacement surgery.Methods Seventy-six patients with cardiac valve replacement surgery in this hospital from March 2018 to January 2020 were selected and divided into the observation group and control group by adopting the random number table method,38 cases in each group.The control group conducted general anesthesia,and the observation group inhaled 1.5-2.0 MAC sevoflurane before aorta opening.The maintenance anesthetic mode was same to the control group.The various indexes were compared between the two groups,including the operation time,cardiopulmonary bypass(CPB)time,intraoperative blood loss volume and anesthesia time,tracheal extubation time,ICU stay time,in-hospital mortality rate,incidence rate of cognitive dysfunction within postoperative 1 week,mini-mental state examination(MMSE)score before operation and at postoperative 6 h,1 d,3 d,serum S-100βprotein and neuron-specific enolase(NSE)levels.Results The operation time,CPB time,intraoperative blood lossvolume and anesthesia time had no statistically significant difference between the two groups(P>0.05).The postoperative tracheal extubation time and ICU stay time in the observation group were significantly shorter than those in the control group(P<0.05).The mortality rate and cognitive dysfunction rate had no statistically significant difference between the two groups(P>0.05).The MMSE scores before operation had no statistical difference between the two groups(P>0.05).The MMSE scores at postoperative 6 h in the two groups were significantly decreased compared with before operation(P<0.05).The MMSE scores on postoperative 1,3 d in the two groups were significantly increased compared with those at postoperative 6 h,moreover the MMSE scores in the observation group were significantly higher than those in the control group(P<0.05)The levels of S-100βprotein and NSE had no statistically sign

关 键 词：心脏瓣膜置换术 神经认知恢复延迟 七氟烷 吸入麻醉 

分 类 号：R614.2[医药卫生—麻醉学]