帕金森病患者行下腹或下肢手术全麻苏醒质量及认知功能的变化

To investigate the emergence quality and cognitive function in Parkinson's patients undergoing lower abdomen or legs surgery with general anesthesia

目的观察帕金森病患者行下腹或下肢手术全麻苏醒苏醒质量及认知功能的变化。方法选择择期在全身麻醉下行下腹或下肢手术的帕金森病患者26例(PD组)和在全身麻醉下行下腹或下肢手术的无帕金森病病史患者26例(NP组),于术前1d采用简易精神状态量表(MMSE)对认知功能评分。两组均使用咪达唑仑、芬太尼、顺阿曲库铵、丙泊酚行麻醉诱导,术中丙泊酚以5mg·kg-1·h-1和瑞芬太尼6μg·kg-1·h-1为起始输注速度,并根据BIS和MAP调节两种麻醉药物输注速度维持适宜麻醉深度,记录低血压发生次数和升压药物用量。术毕停止丙泊酚和瑞芬太尼的输注,观察并记录首次睁眼时间、拔管时间、达OAA/S评分5分时所需时间及术后24h的MMSE评分。结果 NP组术中瑞芬太尼和丙泊酚用量明显多于PD组(P<0.05),NP组血压下降次数和去氧肾上腺素用量明显少于PD组(P<0.05);NP组的首次睁眼时间、拔管时间、达OAA/S评分5分时所需时间明显短于PD组(P<0.05);NP组术后24h的MMSE评分明显高于PD组(P<0.05)。多元线性回归分析显示:帕金森病(β=0.513,t=3.350,P<0.05)是影响达到OAA/S 5分所需时间的显著预测变量(R2=0.256,回归模型F=3.163,P<0.05)。其余因素均为不显著的预测变量。帕金森病(β=0.468,t=3.203,P<0.05)也是影响术后24h MMSE评分的显著预测变量(R2=0.325,回归模型F=4.430,P<0.05)。其余因素均为不显著的预测变量。结论帕金森病患者较非帕金森病患者的全身麻醉苏醒时间延长,术后24h认知功能显著低于非帕金森病患者。

Objective To investigate the emergence quality and cognitive function in Parkinson＇s patients undergoing general anesthesia. Methods Twenty-six Parkinson＇s patients（group PD）and twenty-six non-Parkinson＇s patients（group NP）undergoing selective lower abdominal or lower extremity surgery in general anesthesia were enrolled in the study.Their cognitive functions were assessed one day before operative with Mini-Mental State Examination（MMSE）.Both groups received anesthesia induction with midazolam,fentanyl,cis-atracurium and propofol.Intraoperative anesthesia was maintained with propofol（5 mg · kg-1· h-1）and remifentanil（6μg·kg^-1·h^-1）.The anesthetic infusion rate was adjusted according to bispectral index（BIS）value and mean arterial pressure（MAP）in order to maintain appropriate anesthesia depth.The frequency of hypotension and dosage of vessel pressor agent were recorded.The infusion of propofol and remifentanil were stopped at the end of the surgery.The time to eyes-open,extubation time,time when OAA/S score to 5,and MMSE score 24 hours postoperatively were recorded and compared.Results The time to eyes-open,extubation time,and time when OAA/S score to 5in group PD were longer than those in group NP（P〈0.05）.Postoperative MMSE score in group PD was significantly lower than that in group NP（P〈0.05）.Multiple linear regression analysis revealed that Parkinson＇s disease was a significant predictive variable affecting sedative score and postoperative 24 hour MMSE score,with R2 of 0.256 and 0.325,respectively（P〈0.05）.Conclusion Parkinson＇s patients have longer emergence time and worse cognitive function than non-Parkinson＇s after general anesthesia.