全凭静脉麻醉对妇科腹腔镜手术后早期认知功能的影响

Effect of total intravenous anesthesia on early postoperative cognitive function in patients after gynecological laparoscopic surgery

目的观察全凭静脉麻醉对妇科腹腔镜手术后早期认知功能的影响。方法选择择期妇科腹腔镜手术患者70例,将其随机分为观察组和对照组各35例。观察组术中静脉泵注瑞芬太尼和丙泊酚维持麻醉,对照组吸入七氟烷维持麻醉,观察2组患者术后苏醒时间及拔管时间及患者术前(T0)、术后1h(T1)、术后3h(T2)、术后6h(T3)、术后12h(T4)的简易智力状态量表(MMSE)评分。结果观察组患者术后苏醒时间及拔管时间均短于对照组,差异均有统计学意义(P<0.05)。术前2组患者MMSE评分比较差异无统计学意义(P>0.05);术后1h 2组患者MMSE评分显著降低(P<0.05);观察组患者评分恢复至术前水平时间为3h内,对照组患者MMSE评分恢复至术前水平时间为12h内;观察组患者MMSE评分在术后1、3、6h明显高于对照组(P<0.05)。结论全凭麻醉与吸入麻醉均会引起患者术后一定时间的认知功能减退,但全凭麻醉较吸入麻醉认知功能恢复快。

Objective To observe the effects of total intravenous anesthesia on early postoperative cognitive function in patients after gynecological laparoscopic surgery. Methods 70 patients who would be treated by gynecological laparoscopic surgery were randomly divided into observation group and control group with 35 cases in each group. Observation group was given intravenous infusion of remifentanil and propofol anesthesia during operation; control group inhaled sevoflurane anesthesia.The postoperative recovery time and extubation time and MMSE score before operation（ T0）,1h after operation（ T1）,3h after operation（ T2）,6h after operation（ T3）,12 h after operation（ T4） were recorded in both two groups. Results The postoperative recovery time and extubation time in the observation group was significantly shorter than that of the control group（ P 0. 05）;there were no difference with preoperative score between two groups（ P 0. 05）; the 1h MMSE score of two groups were decreased significantly（ P 0. 05）; the time of postoperative MMSE score recovered to the level before surgery in the observation group were 3 hours,meanwhile the time in the control group were 12 hours; the MMSE score during time postoperative 1、3、6h in observation group were significantly higher than the control group（ P 0. 05）. Conclusion The total intravenous anesthesia and inhaled anesthesia could cause difference degree of postoperative cognitive decline,but patients under total intravenous anesthesia recovered rapidly.