静吸复合麻醉不同镇静深度对妇科腹腔镜术后认知功能的影响

Effects of different depths of sedation during combined intravenous-inlmlational anesthesia on postoperative cognitive function in patients undergoing gynecological laparoscopic surgery

目的评价静吸复合麻醉不同镇静深度对妇科腹腔镜术后认知功能的影响。方法择期妇科腹腔镜手术患者90例，年龄20～64岁，BMI19～30kg／m2，ASA分级Ⅰ或Ⅱ级。采用随机数字表法，将患者分为3组（n=30）。术中吸人七氟醚（呼气末浓度1．0％-1．5％）、静脉输注瑞芬太尼和间断静脉注射罗库溴铵维持麻醉，调控瑞芬太尼静脉输注速率维持BIS值水平，Ⅰ组：30〈BIS值≤40、Ⅱ组：40〈BIS值≤50和Ⅲ组：50〈BIS值≤60。麻醉前1d及术后1d，记录简易精神状态量表（MMSE）评分及连线试验（TMT）完成时间。结果3组患者麻醉前1d和术后1dMMSE评分均〉24分，组内及组间比较差异均无统计学意义（P〉0．05）。与麻醉前1d相比，Ⅰ组和Ⅲ组患者术后1dTMT完成时间延长，Ⅱ组缩短（P〈0．05）；与Ⅰ组和Ⅲ组比较，Ⅱ组术后1dTMT完成时间缩短（P〈0．05）。结论七氟醚-瑞芬太尼静吸复合麻醉维持40〈BIS值≤50镇静深度对妇科腹腔镜术后认知功能影响较小。

Objective To investigate the effects of different depths of sedation during combined intraveno- us-inhalational anesthesia on postoperative cognitive function in patients undergoing gynecological laparoseopie sur- gery. Methods Ninety ASA Ⅰ or Ⅱ patients, aged 20-64 yr, with a body mass index of 19-30 kg/m2 , scheduled for elective gynecological laparoseopie operation, were randomly divided into 3 groups （n = 30 each）. Anesthesia was induced with midazolam, fentanyl, propofol and roeuronium. The patients were tracheal intubated and me- chanically ventilated. Anesthesia was maintained with inhalation of sevoflurane （end-tidal concentration 1.0%- 1.5 % ）, iv infusion of remifentanil and intermittent iv boluses of roeuronium. The infusion rate of remifentanil was adjusted to maintain BIS value ： 30 〈 BIS value ≤40 in groupⅠ , 40 〈 BIS value ≤ 50 in group Ⅱ and 50 〈 BIS value ≤ 60 in group Ⅲ . Cognitive function was assessed using Mini-Mental State Examination （MMSE） and Trail- Making Test （TMT） at 1 d before anesthesia and 1 d after surgery. Results MMSE scores were 〉 24 at 1 d be- fore anesthesia and 1 d after surgery in all the three groups, and there was no significant difference within each group and among the three groups （ P 〉 0.05）. Compared with the baseline value, TMT completion time was sig- nificantly prolonged at 1 d after surgery in groups Ⅰ and Ⅲ , while shortened in group Ⅱ （ P 〈 0.05）. Compared with groups Ⅰ and Ⅲ , TMT completion time was significantly shortened at 1 d after surgery in group Ⅱ （ P 〈 0.05）. Conclusion The depth of sedation, 40 〈 BIS value ≤ 50, during combined intravenous-inhalational anes- thesia with sevoflurane and remifentanil has less influence on postoperative cognitive function in patients undergoinggynecological laparoscopic surgery.