不同麻醉方法与深度对老年髋关节置换术患者术后早期认知功能的影响

Effects of different depths of anesthesia assessed by bispectral index on early postoperative cognitive dysfunction in elderly patients undergoing hip replacement surgery

目的探讨不同麻醉深度和不同麻醉方法(静脉麻醉或静吸复合麻醉)对老年髋关节置换术患者术后早期认知功能障碍(POCD)的影响。方法 80例年龄>55岁、简易智能量表评分≥23分,拟择期全身麻醉下行髋关节置换手术的患者,随机分为静脉麻醉组(V组)和静吸复合麻醉组(C组)。其中V组患者随机分为V1组(术中BIS值维持在50～60)和V2组(术中BIS值维持在40～50);C组患者随机分为C1组(术中BIS值维持在50～60)和C2组(术中BIS值维持在40～50)。采用静吸复合或全凭静脉麻醉维持一定麻醉深度。术后第1、3、7天,分别利用简易智能量表判定患者是否有POCD。同时比较不同麻醉深度和不同麻醉方法对苏醒时间、拔管时间和定向力恢复时间的影响。结果各组相同时间点比较,简易智能量表评分均无统计学差异;简易智能量表评分术后第1天与术前相比具有统计学差异(P<0.05),术后第3、7天与术前相比差异无统计学意义(P>0.05)。与V1、C1组相比,V2、C2组苏醒时间、拔管时间和定向力恢复时间均延长。结论不同麻醉方法与深度对老年髋关节置换术患者术后早期POCD发生率无明显影响。

Objective To evaluate the effects of different depths of anesthesia with bispectral index （BIS） monitoring on early postop- erative cognitive dysfunction （POCD） in elderly patients who undergo hip replacement surgery. Methods Eighty elderly patients [ age 〉 55, mini-mental state examination （MMSE） 〉123, ASA Ⅰ -Ⅱ] undergoing hip replacement surgery were randomly alloca- ted into intravenous anesthetics group （ Group V） and inhalation-intravenous combined anesthesia group （ Group C）. Each group was then divided into two subgroups, i.e. Group V1 （BIS：50 -60） and Group V2 （BIS：40 -50） , or Group C1 （ BIS：50 -60） and Group C2 （BIS：40- 50）. Routine anesthesia introduction was performed. Patients＇ cognitive status was assessed by mini-mental state examination （MMSE） before surgery and on postoperative 1st, 3rd and 7th day. Wake-up time, time to extubation and time of comeback of directional ability were recorded and compared between the groups. Results The score of MMSE was significantly lower on postoperative 1 st day （ P 〈 0.05 ） , and improved on postoperative 3rd and 7th day （ P 〉 0.05 ）. No significant differences were observed between different anesthetic depths or different anesthetic techniques. Compared with Vl and C1 , wake-up time, time to extubation and time of comeback of directional ability in V2 and C2 were longer. Conclusion Different depths of anesthesia and anesthesia with different techniques have no effect on the incidence of early POCD.