丙泊酚与七氟烷复合瑞芬太尼对神经介入手术患者认知功能障碍的影响
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摘要
目的 :研究丙泊酚或七氟烷复合瑞芬太尼对神经介入手术患者认知功能障碍的影响。方法 :选取2013年11月—2016年11月在我院择期拟行全身麻醉下神经介入手术治疗的86例患者为研究对象,按随机数字表法分为两组,各43例。丙泊酚组接受丙泊酚[4～12 mg/(kg·h)]复合瑞芬太尼[0.2μg/(kg·h)]麻醉,七氟烷组接受七氟烷(0.8%～1.8%)复合瑞芬太尼[0.1μg/(kg·min)]麻醉,比较两组围麻醉期相关指标、认知功能障碍(POCD)情况。结果 :七氟烷组自主呼吸时间、睁眼时间、拔除气管导管时间均短于丙泊酚组,去氧肾上腺素和阿托品使用量均显著低于丙泊酚组,差异有统计学意义(P <0.05);七氟烷组术后第1 d、3 d简易智力状态检查量表(MMSE)评分、画钟试验法(CDT)评分显著高于同期丙泊酚组,POCD发生率显著低于同期丙泊酚组,差异均有统计学意义(P <0.05)。结论 :神经介入手术中,七氟烷较丙泊酚复合瑞芬太尼维持麻醉对患者术中血液动力学影响更小,术后清醒更快,血管活性药物用量更少,可显著降低术后认知功能障碍发生率。
Objective: To study the effect of propofol or sevoflurane combined with remifentanil on cognitive dysfunction in patients undergoing neuro-interventional surgery. Methods: 86 patients who underwent neuro-interventional surgery under general anesthesia in our hospital from November 2013 to November 2016 were selected as subjects investigated and randomly divided into two groups, 30 patients in each group. The patients in the propofol group received propofol [4～12 mg/ (kg·h)] combined with remifentanil [0.2 μg/ (kg·h)] anesthesia, and the patients in the sevoflurane group received sevoflurane (0.8%～1.8%) combined with remifentanil [0.1 μg/ (kg·min)] anesthesia. The peri-anesthesia related indexes and postoperative cognitive dysfunction (POCD) were compared between the two groups. Results: The spontaneous breathing time, eyes opening time and tracheal catheter extubation time in the sevoflurane group were shorter than those in the propofol group, and the use amount of phenylephrine and atropine was significantly lower than that in the propofol group (P<0.05). The cores of the mini-mental state examination (MMSE) and clock drawing test (CDT) on the 1 d and 3 d after operation in the sevoflurane group were significantly higher than those in the propofol group, and the incidence of POCD was significantly lower than that in the propofol group (P<0.05). Conclusion: Sevoflurane combined with remifentanil has smaller effect on intraoperative hemodynamics of patients, shorter wake time and less use of vasoactive drugs than propofol combined with remifentanil used for maintaining anesthesia during neuro-interventional surgery, and can significantly reduce the incidence of postoperative cognitive dysfunction.
Objective: To study the effect of propofol or sevoflurane combined with remifentanil on cognitive dysfunction in patients undergoing neuro-interventional surgery. Methods: 86 patients who underwent neuro-interventional surgery under general anesthesia in our hospital from November 2013 to November 2016 were selected as subjects investigated and randomly divided into two groups, 30 patients in each group. The patients in the propofol group received propofol [4～12 mg/ (kg·h)] combined with remifentanil [0.2 μg/ (kg·h)] anesthesia, and the patients in the sevoflurane group received sevoflurane (0.8%～1.8%) combined with remifentanil [0.1 μg/ (kg·min)] anesthesia. The peri-anesthesia related indexes and postoperative cognitive dysfunction (POCD) were compared between the two groups. Results: The spontaneous breathing time, eyes opening time and tracheal catheter extubation time in the sevoflurane group were shorter than those in the propofol group, and the use amount of phenylephrine and atropine was significantly lower than that in the propofol group (P<0.05). The cores of the mini-mental state examination (MMSE) and clock drawing test (CDT) on the 1 d and 3 d after operation in the sevoflurane group were significantly higher than those in the propofol group, and the incidence of POCD was significantly lower than that in the propofol group (P<0.05). Conclusion: Sevoflurane combined with remifentanil has smaller effect on intraoperative hemodynamics of patients, shorter wake time and less use of vasoactive drugs than propofol combined with remifentanil used for maintaining anesthesia during neuro-interventional surgery, and can significantly reduce the incidence of postoperative cognitive dysfunction.
引文
[1]贾喆,纪文军,田波,等.3D-CTA在颅内动脉瘤诊断与治疗中的应用[J].中国CT和MRI杂志,2014,12(3):29-31.
[2]高敏,刘文雄,宁俊萍.全身与局部麻醉对老年急性出血性脑卒中患者术后认知功能的影响比较[J].医学临床研究,2016,33(9):1773-1775.
[3]米小昆,刘青蕊,王佳,等.海马体积测量联合MMSE评分在认知障碍中的应用[J].实用放射学杂志,2017,33(2):178-180.
[4]何婷婷,张允岭,金香兰.3分法画钟测验对区别轻中度血管性痴呆的作用探讨[J].现代中西医结合杂志,2013,22(5):457-458.
[5]Hanning C D.Postoperative cognitive dysfunction[J].Der Anaesthesist,2005,54(6):481-482.
[6]余清.丙泊酚与七氟烷麻醉对骨科老年手术患者术后认知功能的影响[J].蚌埠医学院学报,2013,38(8):982-984.
[7]王永宏,崔晓岗,李斌,等.七氟烷丙泊酚复合麻醉对老年胃癌患者术后早期认知功能的影响[J].现代中西医结合杂志,2015,24(11):1230-1232.
[8]田松,魏巍.丙泊酚和七氟烷对老年全身麻醉患者术后神经及认知功能影响的比较[J].医学综述,2016,22(19):3912-3915.
[2]高敏,刘文雄,宁俊萍.全身与局部麻醉对老年急性出血性脑卒中患者术后认知功能的影响比较[J].医学临床研究,2016,33(9):1773-1775.
[3]米小昆,刘青蕊,王佳,等.海马体积测量联合MMSE评分在认知障碍中的应用[J].实用放射学杂志,2017,33(2):178-180.
[4]何婷婷,张允岭,金香兰.3分法画钟测验对区别轻中度血管性痴呆的作用探讨[J].现代中西医结合杂志,2013,22(5):457-458.
[5]Hanning C D.Postoperative cognitive dysfunction[J].Der Anaesthesist,2005,54(6):481-482.
[6]余清.丙泊酚与七氟烷麻醉对骨科老年手术患者术后认知功能的影响[J].蚌埠医学院学报,2013,38(8):982-984.
[7]王永宏,崔晓岗,李斌,等.七氟烷丙泊酚复合麻醉对老年胃癌患者术后早期认知功能的影响[J].现代中西医结合杂志,2015,24(11):1230-1232.
[8]田松,魏巍.丙泊酚和七氟烷对老年全身麻醉患者术后神经及认知功能影响的比较[J].医学综述,2016,22(19):3912-3915.