不同全麻方法对青年患者颌面部手术后早期认知功能影响研究

Effects of two different methods of general anesthesia on early postoperative cognitive function in patients undergoing maxillofacial surgery

目的观察和比较两种不同全身麻醉方法对青年患者颌面部手术后早期认知功能的影响。方法选取2009年2—5月中国医科大学口腔医学院择期行口腔颌面部手术青年(18～39岁)患者80例,随机分为两组,Ⅰ组为丙泊酚复合瑞芬太尼全凭静脉麻醉,Ⅱ组为七氟烷复合瑞芬太尼静吸复合麻醉,每组各40例。记录两组患者术后苏醒情况(包括睁眼时间、拔管时间、听从指令时间、定向力恢复时间)。采用简易精神状态量表(MMSE)对术前1天以及术后第1、3、7天的认知功能进行测试评估。结果Ⅰ组患者听从指令时间与定向力恢复时间均早于Ⅱ组患者,差异均有统计学意义(P<0.05),术后第1天Ⅰ组和Ⅱ组患者MMSE评分均较术前基础值略有降低,术后第3天恢复至术前,两组术后第7天MMSE评分略有升高,两组间术后各时段比较差异均无统计学意义(P>0.05)。Ⅰ、Ⅱ组患者术后第1天发生术后认知功能障碍(POCD)分别为1例和2例。结论全凭静脉麻醉和静吸复合麻醉对青年患者颌面部手术后早期认知功能均有不同程度的影响,可引起一过性POCD。

Objective To observe and compare the effects of two different methods of general anesthesia on early postoperative cognitive function in young patients undergoing maxillofacial surgery,and to offer clinical referrence. Methods Eighty young patients（aged 18～39 years） ,scheduled for maxillofacial surgery at the Stomatology Hospital Affiliated to China Medical University from Feb. to May,were randomly divided into 2 groups（n=40）：groupⅠ（total intravenous anesthesia with propofol and remifentanil） ,groupⅡ（intravenous-inhalation combined anesthesia with sevoflurane and remifentanil） . Time of eye opening,extubation,response to commands and orientation of 2 groups were recorded after operation. To assess cognitive function using Mini-Mental State Examination（MMSE） ,in different time points of preoperatively,1 day and 3,7 days postoperatively. Results The time of response to commands and orientation in groupⅠwere significantly shorter than those in groupⅡ（P 0.05）;MMSE scores were similar 1 day preoperatively and 3 days postoperatively,while MMSE scores were sligtly lower in both groups on day 1 after operation than those preoperativly;MMSE scores were slightly higher in both groups on day 7 postoperatively than those preoperatively;MMSE scores were similar at every time points between the two groups（P 0.05） . 1 case of groupⅠ and 2 cases of groupⅡhad POCD on day1 after operation. Conclusion Using MMSE to assess cognitive function,total intravenous anesthesia and intravenous-inhalation combined anesthesia may affect early postoperative cognitive function of patients aged 18～39 years undergoing maxillofacial surgery to different extent,and may induce POCD transiently.