不同麻醉方式对腹膜假黏液瘤患者热灌注化疗术后认知功能的影响

Influence of different anesthesia on postoperative cognitive function in patients with pseudomyxoma peritoneum after intraperitoneal chemohyperthermia surgery

目的 观察2种不同麻醉方式对腹膜假黏液瘤患者热灌注化疗术后认知功能的影响.方法 选择2012年1月至2014年12月就诊于航天中心医院的腹膜假黏液瘤患者48例,采用随机数字表法分为观察组和对照组,各24例.麻醉诱导均采用静脉注射咪达唑仑0.03-0.05 mg/kg,丙泊酚1.5- 2.0 mg/kg,罗库溴铵0.6 mg/kg,舒芬太尼0.3-0.5 μg/kg.观察组采用吸入七氟醚至潮气末1-2倍最小肺泡内浓度（MAC）,复合静脉持续输注瑞芬太尼0.05-0.20 μg/（kg·min）维持麻醉.对照组采用吸入七氟醚至潮气末0.5 -1.0倍MAC,复合静脉持续输注丙泊酚2-4 mg/（kg·h）及瑞芬太尼0.05 -0.20 μg/（kg·min）维持麻醉.记录2组手术时间、麻醉时间、术中热灌注化疗时间、术中出血量、咽温.分别于术前和术后1周使用简易精神状态检查量表和韦氏成人记忆量表及智力量表中的6项敏感指标（累加测试、视觉再生、联想学习、数字广度、数字符号、连线测试）对所有患者进行神经精神功能测试,并记录患者认知功能障碍发生情况.结果 观察组和对照组患者手术时间、麻醉时间、热灌注时间、术中出血量、咽温最高值比较[（474±58） min比（455±85） min,（501±58）min比（490±85） min,（80±11） min比（76±13） min,（2 108±1 673） ml比（2 033±691） ml,（38.5±0.6）℃比（38.8±0.6）℃],差异均无统计学意义（均P＞0.05）.2组术前神经精神功能各项评分及观察组术后1周与术前神经精神功能各项评分比较,差异均无统计学意义（均P＞0.05）.对照组术后1周视觉再生、数字广度、数字符号、连线测试得分与术前比较[（8.2±2.2）分比（9.6±1.2）分、（10.0±1.0）分比（11.5±1.4）分、（30.6±9.1）分比（38.6±9.6）分、（53.1±16.6）分比（39.2±10.5）分],差异有统计学意义（P＜0.05）.术后1周观察组连线测试得分与对照组比较[（41.5±14.5）分比（53.1±16.6）分],差异有统计学意义（P＜0.05）.观察组术后认知功能障碍发生率与对照组比较[8.3％ （2/24）比16.7％ （4/24）],差异无统计学意义（P＞0.05）.结论 热灌注化疗患者采用1-2倍MAC七氟醚吸入麻醉对术后认知功能的影响小于0.5-1.0倍MAC七氟醚吸入复合丙泊酚静脉输注麻醉.

Objective To investgate influence of different anesthesia on postoperative cognitive function in patients with pseudomyxoma peritoneum after intraperitoneal chemohyperthermia surgery.Methods Totally 48 patients with pseudomyxoma peritoneum who underwent intraperitoneal chemohyperthermia surgery from January 2012 to December 2014 were randomly divided into observation group and control group,24 cases in each group.In both groups,anesthesia was induced by midazolam （0.03-0.05 mg/kg）,propofol phenol （1.5-2.0 mg/kg）,rocuronium 0.6 mg/kg,sufentanil （0.3-0.5 μg/kg）.Observation group was given inhalation of sevoflurane [end expiratory 1-2 minimum alveolar concentration （MAC）] combined with intravenous infusion of fentanyl [0.05-0.20 μg/（kg.min）] for maintenance of anesthesia;control group was given inhalation of sevoflurane （end expiratory 0.5-1.0 MAC） combined with intravenous infusion of propofol [2-4 mg/（kg · h）] and fentanyl [0.05-0.20 μg/（kg · min）] for maintenance of anesthesia.The durations of operation,anesthesia,intraperitoneal chemohyperthermia,the intraoperative blood loss,and the pharynx temperature were recorded.The Wechsler adult intelligence scale （accumulative test,visual regeneration,associative learning test,digit span,digit symbol,link test） was used to assess the mental function before and 1 week after operation;the incidence of postoperative cognitive dysfunction （POCD） was recorded.Results The durations of operation,anesthesia time and intraperitoneal chemohyperthermia,the intraoperative blood loss and the highest pharynx temperature were not significantly different between observation group and control group [（474 ± 58） min vs （455 ± 85） min,（501 ± 58） min vs （490 ±85）min,（80 ± 11）min vs （76 ±13）min,（2 108±1 673） ml vs （2033 ±691） m1,（38.5 ±0.6） ℃ vs （38.8 ± 0.6） ℃] （P 〉 O.05）.The scores of accumulative test,visual regeneration,associative learning test,digit span,digit symbol,link test were not significantly different before operation （P 〉 0.05）;in observation group they were not significantly changed 1 week after operation （P 〉 0.05）;in control group,the scores of visual regeneration,digit span,digit symbol and connection test after operation 1 week were significantly different with those before operative [（8.2 ±2.2） scores vs （9.6 ± 1.2） scores,（10.0 ± 1.0） scores vs （11.5 ± 1.4） scores,（30.6 ±9.1） scores vs （38.6 ±9.6） scores,（53.1 ± 16.6） scores vs （39.2 ± 10.5） scores] （P 〈0.05）;the score of connection test in observation group was significantly lower than that in control group [（41.5 ± 14.5） scores vs （53.1 ± 16.6） scores] （P 〈0.05）.The incidence of POCD was not significantly different between observation group and control group [8.3% （2/24） vs 16.7% （4/24）] （P〉0.05）.Conclusion Inhalation of 1-2 MAC sevoflurane for maintenance of anesthesia has less influence on postoperative cognitive function compared with inhalation of 0.5-1.0 MAC sevoflurane combined with intravenous infusion of propofol in patients undergoing intraperitoneal chemohyperthermia surgery.