不同全麻方法对正颌手术后早期认知功能的影响

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

目的:观察和比较两种不同全麻方法对青年患者正颌手术后早期认知功能的影响。方法:选取2010年1～9月中国医科大学附属口腔医院择期行正颌手术青年患者(18～39岁)60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30例,记录两组患者术后苏醒情况。采用简易精神状态量表(MMSE)对术前1天以及术后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),I、II组患者术后第1天发生术后认知功能障碍(POCD)各有1例。结论:采用MMSE评估,全凭静脉麻醉和静吸复合麻醉对青年患者正颌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 early postoperative cognitive function with two different methods of general anesthesia in young patients undergoing maxillofacial orthognathic surgery,and to offer clinical reference.Methods：Sixty young patients（aged 18～39years）,scheduled for orthognathic surgery at the Stomatology Hospital affiliated to China Medical University from Jan.to Sep.2010,were randomly divided into 2 groups（n=30）： Group I received total intravenous anesthesia with propofol and remifentanil group II received intravenous-inhalation combined anesthesia with sevoflurane and remifentanil.Postoperative recovery condition of 2 groups were recorded.To assess cognitive function using Mini-Mental State Examination（MMSE）,in different time points of preoperatively,1 day and 3,7 day postoperatively.Results： The time of response to commands and orientation in group I were significantly shorter than those in group II（P〈0.05）,1 case in every group had POCD on day1 after operation.Conclusions： Using MMSE to assess cognitive function,total intravenous anesthesia and intravenous-inhalation combined anesthesia may affect early postoperative cognitive function of young patients,undergoing orthognathic surgery in different extent,and may induce POCD transiently.