全身麻醉方式对全子宫切除术患者术后认知功能的影响被引量：24

Effect of general anesthetic mode on postoperative cognitive dysfunction in patients undergoing laparoscopic radical hysterectomy

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摘要目的探讨两种全身麻醉方式对腹腔镜下根治性广泛全子宫切除术患者术后认知功能的影响。方法将100例择期腹腔镜下根治性广泛全子宫切除术患者分为两组:丙泊酚组(P组)、七氟醚组(S组),每组各50例。记录麻醉时间、舒芬太尼用量、维库溴铵用量、苏醒时间、定向力恢复时间,记录麻醉复苏期并发症。分别于术前1d(T_0)、术后1d(T_1)、术后3d(T_2)、术后7d(T_3)、术后1个月(T_4)、术后3个月(T_5)对患者进行简易智能状态量表(MMSE)评分,采用Z计分法评定术后认知功能障碍(POCD)发生情况。结果与P组比较,S组舒芬太尼用量及维库溴铵用量较少(P<0.05),苏醒时间及定向力恢复时间增加(P<0.05),S组患者出现寒战、躁动、上呼吸道梗阻较多(P<0.05)。组间MMSE评分变化相比较,差异无统计学意义(F=0.14,P=0.709);时间点MMSE评分变化相比较,差异有统计学意义(F=74.46,P<0.01);全身麻醉方式与时间MMSE评分之间存在交互效应(F=7.99,P<0.01);与P组比较,T_1、T_2时间点S组MMSE评分较低(P<0.05),S组中T_1、T_2、T_3、T_4时间点POCD发生率高(P<0.05)。结论腹腔镜下根治性广泛全子宫切除术中,采用七氟醚吸入麻醉患者较丙泊酚麻醉患者POCD发生率较高,但3个月后POCD发生率无差异。 Objective To investigate the influence of two general gnesthestic modes on postoperative cognitive dysfunction （POCD） in the patients undergoing laparoscopic radical hysterectomy. Methods One hundred ASA Ⅰ-Ⅱ patients undergoing laparoscopic radical hysterectomy were randomly allocated to the propofol group （group P） and sevoflurane group （group S）.50 cases in each group. The anaesthesia time, total dose of sufentanil, total dose of vecuronium,recovery time, recovery time for regaining orientation and complications during anesthetic recovery period were recorded. The cognitive function was assessed by the mini-mental state examination （MMSE） on preoperative 1 d （T0）, postoperative 1 d （T1）, postoperative 3 d, （T2）, postoperative 7 d （T3 ）, postoperative 1 month （T4）,postoperative 3 months （T5） and the POCD occurrence situation was evaluated by adopting the Z scoring, Results The total dose of sufentanil and vecuronium in the group S was lower than that in the group P （P〈0. 05） ,the recovery time and time for regaining orientation m the group S was longer than that in the group P （P〈0.05） ;the incidence rates of shive- ring, dysphoria and upper respiratory tract obstruction in the group S were higher than those in the group P （P〈0. 05）. There were no statistically significant difference in the MMSE scores between the two groups （F=0. 14 ,P=0.709）; the MMSE scores in each group had statistical differences among different time points （F=74.46,P〈0.01）. The interaction effect existed between the general anesthetic mode and time with MMSE score （F= 7.99 ,P〈0.01） ;the MMSE scores at T1 ,T2 in the group S were lower than those in the group P （P〈0.05）. The incidence rate of POCD at T1 ,T2,T3 ,T4 in the group S was higher than that in the group P （P〈0.05）. Conclusion The incidence rate of POCD in the patients undergoing taparoscopic radical hysterectomy by adopting sevoflurane inhalation general anaesthesia is higher than that by adopting propofol anesthesia, but which has no difference after postoperative 3 months.

作者郭翠容陆立仁王志强彭志勇郑映金

机构地区广东省佛山市南海区妇幼保健院麻醉科南方医科大学附属南海医院麻醉科

出处《重庆医学》 CAS 北大核心 2016年第20期2769-2771,2774,共4页 Chongqing medicine

基金广东省佛山市医学类科技攻关项目(2014AB000602)

关键词子宫切除术腹腔镜检查术后认知功能障碍丙泊酚七氟醚 hysterectomy laparoscopy postoperative cognitive dysfunction propofol sevoflurane

分类号 R614.2 [医药卫生—麻醉学]

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参考文献12

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