不同麻醉方式对帕金森病患者术后认知功能的影响

Influence of different anesthesia methods on postoperative cognitive function in Parkinson disease patients

目的探讨不同麻醉方式对帕金森病患者术后认知功能的影响。方法选择行下腹部或下肢手术的帕金森病患者48例,随机分入全凭静脉麻醉组(TIVA组)和蛛网膜下腔阻滞联合硬脊膜外腔阻滞麻醉组(CSEA组),每组24例。采用简易精神状态量表(MMSE)分别于术前1d和术后1、2、3、4、7d评估患者的认知功能。比较两组患者手术前后的MMSE评分。以性别、年龄、受教育时间、帕金森病Hoehn-Yahr分期、帕金森病病程、手术时间、手术类型、麻醉方式、麻醉时间、术中出血量、术前MMSE评分为自变量,以术后1d的MMSE评分为因变量,进行多元线性回归分析。结果两组间术前1d和术后2、3、4、7d的MMSE评分的差异均无统计学意义(P值均>0.05),TIVA组术后1d的MMSE评分显著低于CSEA组同时间(P<0.05)。两组术后1、2、3、4、7d的MMSE评分均显著低于同组术前1d(P值均<0.01),术后1d的MMSE评分均显著低于同组术后2、3、4、7d(P值均<0.01)。多元线性回归分析显示,麻醉方式(β=0.306,t=2.805,P=0.008)、帕金森病Hoehn-Yahr分期(β=-0.385,t=-3.104,P=0.004)、手术时间(β=-0.421,t=-1.088,P=0.043)、麻醉时间(β=-0.569,t=-0.759,P=0.041)、术前1d的MMSE评分(β=0.371,t=2.283,P=0.008)均为术后1d的MMSE评分的显著预测因素(R2=0.728,F=9.649,P<0.05)。结论两种麻醉方式下帕金森病患者术后均出现认知功能改变,与全凭静脉麻醉比较,蛛网膜下腔阻滞联合硬脊膜外腔阻滞麻醉对患者认知功能的影响较小。

Objective To investigate the influence of different anesthetic methods on postoperative cognitive function in patients with Parkinson disease. Methods A total of 48 patients with Parkinson disease undergoing lower abdominal surgery or lower limb surgery were selected as subjects. They were randomized into total intravenous anesthesia（TIVA） group and combined spinal-epidural anesthesia （CSEA） group with 24 patients in each group. Mini-Mental State Examination （MMSE） was used to evaluate the cognitive function of patients at 6 time points; 1 d before operation and 1, 2, 3, 4, 7 d after operation. Multiple linear regression analysis was performed, with gender, age, education time, Hoehn-Yahr stage of Parkinson disease, course of Parkinson disease, duration of operation, operation type, anesthesia method, duration of anesthesia, intraoperative blood loss and preoperative MMSE score as independent variables, and the MMSE score 1 d after operation as dependent variable. Results There was no significant difference between two groups in the MMSE scores 1 d before operation or 2, 3, 4, 7 d after operation （all P〉0.05）, but the MMSE Score of TIVA group 1 d after operation was significantly lower than that of CSEA group （P〈0.05）. In both groups, the MMSE scores on day 1, 2, 3, 4 and 7 after operation were significantly lower than those on day 1 before operation （all P〈0.01）, and the MMSE score on day 1 after operation was significantly lower than those on day 2, 3, 4 and 7 after operation （all P〈0.01 ）. The multiple linear regression analysis showed that the anesthesia method （β = 0. 306, t =2. 805, P = 0. 008）, Parkinson disease Hoehn-Yahr stage （β = - 0. 385, t = - 3. 104, P= 0. 004）, duration of operation （β = - 0.421, t = - 1. 088, P = 0. 043）, duration of anesthesia （β = - 0. 569, t = - 0. 759, P = 0.041 ） and MMSE score on day 1 before operation （β = 0.371, t = 2. 283, P = 0. 008） were all significant predictive variables for the MMSE score on day 1 after operation （R2 = 0. 728, F=9. 649, P〈0.05）. Conclusion Both CSEA and TIVA can affect postoperative cognitive function of patients with Parkinson disease. CSEA has less influence compared with TIVA.