两种不同全麻方案对控制性降压下膝关节置换患者认知功能的影响  

Effects of two different general anesthesia programs on cognitive function in patients with knee replacement under controlled hypotension

作　　者：孔锋 谢传彬 吴昊 孙江涛 KONG Feng;XIE Chuanbin;WU Hao;SUN Jiangtao(Department of Anesthesiology,SuiXi County Hospital of Traditional Chinese Medicine,Suixi 235131,Anhui Province,China;Department of Anesthesiology,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,Anhui Province,China;Department of Orthopedics and Traumatology,SuiXi County Hospital of Traditional Chinese Medicine,Suixi 235131,Anhui Province,China)

机构地区：[1]濉溪县中医医院麻醉科,安徽滩溪235131 [2]安徽医科大学第一附属医院麻醉科,安徽合肥230022 [3]濉溪县中医医院骨伤科,安徽滩溪235131

出　　处：《世界临床药物》2024年第11期1168-1174,共7页World Clinical Drug

摘　　要：目的探讨两种不同全麻维持方案对控制性降压下全膝关节置换术(total knee arthroplasty,TKA)患者术后认知功能的影响。方法纳入2021年1月至2023年6月濉溪县中医医院收治的初次接受TKA患者90例,依据麻醉维持方案分为七氟醚组(n=46)和丙泊酚组(n=44)。观察两组术中输液量、出血量、尿量、平均动脉压(mean arterial pressure,MAP)、局部脑氧饱和度(regional oxygen saturation,rSO2)、简易智力状态检查(mini-mental state examination,MMSE)评分及中文版老年谵妄评估量表(confusion assessment method-Chinese revision,CAM-CR)评分。结果术前,两组性别、侧位、年龄、体质量指数、美国麻醉医师协会分级、术前血红蛋白和基础疾病、MMSE和CAM-CR评分无显著差异(P>0.05)。术中,两组输注量、出血量、手术时间、尿量和红细胞压积无显著差异(P>0.05)。手术开始至麻醉结束,两组MAP、rSO2水平均较术前下降(P<0.05),且丙泊酚组rSO2水平低于七氟醚组(P<0.05)。麻醉结束时,两组MAP、rSO2水平逐步恢复,但丙泊酚组仍低于七氟醚组(P<0.05)。术后D1,七氟醚组发生术后认知功能障碍(postoperative cognitive dysfunction,POCD)4例,丙泊酚组13例,差异有统计学意义(P<0.05);丙泊酚组MMSE、CAM-CR评分低于七氟醚组(P<0.05)。结论七氟醚较丙泊酚可有效预防控制性降压对脑组织的影响,保证TKA围手术期安全,减少POCD等并发症。Objective To investigate the effects of two different general anesthesia maintenance programs on postoperative cognitive function in patients undergoing total knee arthroplasty(TKA)under controlled hypotension.Methods Ninety patients who received TKA for the first time in Suixi County Hospital of Traditional Chinese Medicine from January 2021 to June 2023 were included and divided into sevoflurane group(n=46)and propofol group(n=44)according to anesthesia maintenance regimen.The amount of infusion,blood loss,urine volume,mean arterial pressure(MAP)and regional oxygen saturation(rSO2),mini-mental state examination(MMSE)score and confusion assessment method-Chinese revision(CAM-CR)score were observed in the two groups.Results Before operation,there were no significant differences in gender,lateral position,age,body mass index,American College of Anesthesiologists grade,preoperative hemoglobin and underlying diseases,MMSE and CAM-CR scores between the two groups(P>0.05).There were no significant differences in intraoperative infusion volume,blood loss,operative time,urine volume and hematocrit between the two groups(P>0.05).From the beginning of surgery to the end of anesthesia,MAP and rSO2 levels in both groups were significantly decreased compared with those before surgery(P<0.05),and rSO2 level in propofol group was significantly lower than that in sevoflurane group(P<0.05).At the end of anesthesia,the levels of MAP and rSO2 in both groups gradually recovered,but the propofol group was still lower than that in sevoflurane group(P<0.05).On postoperative D1,there were 4 cases of postoperative cognitive dysfunction in sevoflurane group and 13 cases in propofol group,and the difference was statistically significant(P<0.05).The MMSE and CAM-CR scores of propofol group were lower than those of sevoflurane group(P<0.05).Conclusion Compared with propofol,sevoflurane can effectively prevent the influence of controlled hypotension on brain tissue,ensure the perioperative safety of TKA,and reduce postoperative cognitive dys

关 键 词：七氟醚 丙泊酚 全膝关节置换术 术后认知障碍 控制性降压 

分 类 号：R614[医药卫生—麻醉学]