靶控输注全凭静脉麻醉与静吸复合麻醉对术后认知功能影响的比较

Comparison of Postoperative Cognitive Function with Target Control Infusion/Total Intravenous Anesthesia and Intravenous-inhaltion Combined Anesthesia

【目的】比较靶控输注瑞芬太尼和丙泊酚全凭静脉麻醉与地氟醚和芬太尼静吸复合麻醉对术后认知功能的影响。【方法】选择ASAΙ～II级,年龄18～65岁(男27例,女17例)择期行鼻内镜手术的病人44例,随机分两组:靶控输注瑞芬太尼加丙泊酚全凭静脉麻醉组(TCI组)24例,地氟醚加芬太尼静吸麻醉组(DF组)20例。于麻醉诱导前及术后1、3、24h应用mini-mentalstate(MMS)测试方法评定其认知功能。比较两组术后麻醉苏醒恢复情况及手术后并发症。【结果】①两组病人在相同麻醉深度下,即脑电双频指数(bispectralindex,BIS)术中维持在40～60,各时间点MMS评分组间比较差异无统计学意义(P>0.05);组内比较仅在术后1h均较术前显著降低,术后3h即恢复至术前水平。术后1hTCI组有6例(25%)、DF组有9例(42.9%)病人有明显的认知功能降低,术后3hDF组有2例(10%)病人的MMS值较低(<28分),而TCI组所有病人认知功能已恢复。②TCI组呼吸恢复时间、听从指令时间及定向力恢复时间均早于DF组,差异有统计学意义(P分别为0.02,0.03和0.02)。拔管时间,呼之睁眼时间也早于DF组,但无统计学意义。③TCI组在拔管即刻的OAAS评分高于DF组,有统计学意义(P=0.007)。④两组病人术后恶心呕吐发生率无差异,两组均无术中知晓发生。【结论】靶控输注瑞芬太尼和丙泊酚全凭静脉麻醉用于鼻内镜手术可引起一过性术后认知功能障碍,与地氟醚和芬太尼静吸复合麻醉相似。

[Objective] To compare postoperative cognitive function with the target-controlled infusion/TIVA anesthesia and intravenous-inhalation combined anesthesia in patients undergoing endoscopic sinus surgery. [Methods] Forty-four ASA Ⅰ - Ⅱ patients （27 male and 17 female） aged 18-65 years undergoing endoscopic sinus surgery were randomized two groups to receive target-controlled infusion with remlfentanil and propofol （TCI group） or desflurane-fentanyl （DF group）. To assess cognitive function before induction and at 1 h, 3 h, and 24 h after operation using Mini-Mental State （MMS） test, and to compare the recovery profiles and postoperative complications between the two groups. [Results] （1） In the same deep of anesthesia[（bispectral index,BIS） was 40-60], there were no significant difference in MMS score between the two groups before and after surgery （P 〉0.05）. The MMS scores decreased significantly at only 1 h after surgery compared with those before surgery in both groups, and returned to preoperative baseline levels within 3 h after surgery. The percentage of the patients who developed postoperative cognitive dysfunction （POCD） was 42.9% at 1 h after operation and 10% at 3 h after operation in DF group. In TCI group the percentage of patients who developed POCD was 25% at 1 h after operation. （2）Early recovery times （recovery of spontaneous breathing, response to commands, orientation） was significantly shorter in the TCI group than that in the DF group （P= 0.02, 0.03 and 0.02）, And eye opening and extubation were similar between two groups. （3） OAA/S score （5=fully conscious, 1=deep sleep） was significantly higher at extubation in TCI group than that in DF group. （4） The incidence of postoperative nausea and vomiting was similar in both groups. No awareness happened in two groups during operation. [Conclusion] Target controlled infusion anesthesia with propefol and remifentanil may induce temporarily postoperative cognitive dysfunction, and is similar to desflurane-fentanyl anesthesia.