依达拉奉预处理对全麻老年患者术后认知功能评分的影响

Effects of edaravone pretreatment on postoperative cognitive function score in elderly patients undergoing general anesthesia

目的：评价依达拉奉预处理对全麻老年患者术后认知功能评分的影响。方法选择全麻患者90例，性别不限，年龄65~80岁，体重48~79kg，ASA分级Ⅱ或Ⅲ级，采用随机数字表法，将患者分为3组：对照组（C组）、依达拉奉30mg组（D1组）和依达拉奉60mg组（D2组），每组30例。麻醉诱导前将依达拉奉单次剂量30mg、60mg分别加入250ml生理盐水静脉输注，输注时间为20分钟，C组给予等容量生理盐水。采用近红外光谱（near infrared reflectance spectroscopy technique，NIRS）监测术前、手术结束后6小时（T1）、12小时（T2）、1天（T3）、3天（T4）、7天（T5）的脑组织氧饱和度（rSO2）。并于术前1天和术后7天采用简易智能量表（mini mental state examination，MMSE）、蒙特利尔认知评估量表（Montreal Cognitive Assessment，MoCA）对患者进行认知功能测试，记录术后认知功能障碍（postoperative cognitive dysfunction，POCD）的发生情况。结果与C组比较，D1组和D2组rSO2、MMSE、MoCA评分升高(P<0.05)，D1组和D2组间上述指标差异无统计学意义（P>0.05）。结论依达拉奉预处理可以显著提高脑组织氧饱和度，改善全麻老年患者术后认知功能评分，有助于减少老年患者POCD的发生。

Objective To evaluate the effects of edaravone pretreatment on postoperative cognitive function scores in elderly patients undergoing general anesthesia.Method Ninety ASA physical status Ⅱ or Ⅲ patients,aged 65 ~ 80 y,weighing 48 ~ 79 kg,scheduled for elective surgery under general anesthesia,were randomly assigned into 3 groups(n=30,respectively):group C(control group),group D1(edaravone 30 mg group) and group D2(edaravone 60 mg group).Patients were treated intravenously with edaravone 30mg(group D1) or 60mg(group D2) in 20 min before anesthesia,and control group(group C) were treated with normal saline. Near infrared spectroscopy(NIRS) was used to monitor the brain tissue oxygen saturation(rSO2) of patients 1d before surgery and 6h(T1),12h(T2),1d(T3),3d(T4),7d(T5) after surgery. The cognitive function was evaluated by Mini-Mental State Examination(MMSE) and Montreal Cognitive Assessment(MoCA) at 1d before and 7d after operation. The development of POCD was recorded.Result Compared with group C,the rSO2,MMSE,MoCA scores were significantly increased in group D1 and D2,and no significant differences were found in the indices mentioned above between D1 and D2 groups.Conclusion Edaravone pretreatment can significantly improve rSO2, postoperative cognitive function score and might prevent the development of POCD in the elderly patients undergoing general anesthesia.