异丙酚靶控输注麻醉对术后意识和认知功能的影响

Effect of target controlled infusion of propofol on postoperative awareness and cognitive function

目的:评价在脑电双频指数(BIS)的监测下,异丙酚复合阿曲库铵、舒芬太尼静脉全麻(观察组)及异丙酚复合阿曲库铵、舒芬太尼、异氟醚静吸复合全麻(对照组),分别对患者术后意识恢复和认知功能的影响。方法:ASA评级Ⅰ～Ⅱ,气管插管全麻下行腹腔镜手术的患者40例,术前让患者观察并熟记5张相似图片中的1张图片。术中异丙酚靶控输注(TCI)维持麻醉,通过调控血浆靶浓度使BIS维持在50～60之间。记录麻醉诱导前(基数)、气管插管后、气腹后、术毕、拔管后、唤之可醒和认图时的BIS值,术毕停药到唤之可醒的时间和唤之可醒时的异丙酚效应室浓度。在麻醉恢复室让患者从术前观察的5张图片中挑选出熟记的图片,记录结果和BIS值以及从唤之可醒到可清楚认图的时间。术后24h随访,以视觉模拟评分(VAS)对患者身体恢复进度和心理状况进行评分。结果:观察组20例患者均可正确辨认术前所看图片并回答切题;对照组20例患者中12例能辨认且对答切题,其余8例术后苏醒时间延长,无法辨认术前所看图片或回答不切题。术后的身体恢复进度VAS评分为(72±12)分;心理状况VAS评分为(73±15)分。结论:异丙酚复合阿曲库铵、舒芬太尼静脉全麻对术后意识和认知功能恢复无影响,而异丙酚复合阿曲库铵、舒芬太尼、异氟醚静吸复合全麻方式可使术后苏醒时间延长,对术后意识和认知功能有一定的影响。

Objective：To evaluate the effect of propofol intravenous anesthesia with atracurium and sufentanil and propofol anesthe- sia with atraeurium,sufentanil and isoflurane inhalation on postoperative awarness and cognitive function under bispeetral index（BIS） monitoring.Methods：The laparoscopic surgery in 40 patients with ASA Ⅰ - Ⅱ was performed under tracheal intubation anesthesia,all eases were told to observe five similar pictures and memorize one of them before operation.The propofol target controlled infusion （TCI） was used to maintain anesthesia by regulating the target plasma concentration of BIS maintained between 50 to 60 during the operation.The base before the induction of anesthesia and after the tracheal intubation,pneumoperitoneum,operation and extubation,the BIS value of wake up and recognizing the picture,the time of withdrawal drug to wake up and the concentration of propofol effect room of wake up were recorded respoetively.In the anesthetic recovery room, the patients were told to select the memorizing picture, the result, BIS value as well as the time of wake up to clear recognizing the picture were record respectively.During a follow-up of 24 hours after operation,the recovery progress and psychic status in all patients were scored with the visual analog scale （VAS）.Results：20 patients in the observation group could correctly identify the picture memorized before operation, and answer the questions.In the control group, 12 of 20 patients had the same effect as the observation group,the other 8 cases,whose time of awake after operation was prolonged ,did not identify the picture memorized before operation and answer the questions.The VAS score of recovery progress was 72±12;the VAS score of psychic status was 73±15.Conclusion：Propofol intravenous anesthesia with anracurium and sufentanil had no effect on postoperative awareness and cognitive funetion ,while propofol with atracurium ,sufentanil and isoflurane inhalation anesthesia could make the time of postoperative awake prolongating, and had a certain influence on postoperative awareness and cognitive function.