不同镇静深度静吸复合麻醉对老年腹腔镜腹部手术患者术后认知功能的影响比较

Comparison of Cognitive Function of Elderly Patients with Laparoscopic Abdominal Surgery with Different Depths of Sedation

目的:比较不同镇静深度静吸复合麻醉对老年腹腔镜腹部手术患者术后认知功能的影响。方法:选择我院2014年3月-2015年3月90例拟择期行腹部手术的老年患者随机分为A、B、C三组,每组30例,采用不同深度静吸复合麻醉,根据BIS指数调节七氟醚浓度和瑞芬太尼输注速率,其中A组维持BIS值水平51-60,B组维持BIS值水平41-50,C组维持BIS值水平31-40,于术前1d和术后1 d对患者认知功能进行测评。结果:各组麻前1 d A组TMT完成时间和MMSE评分比较差异无显著性(P>0.05)。A组术后24 h认知功能下降发生率为30.0%,B组术后24 h认知功能下降发生率为23.33%,C组认知功能下降发生率为16.67%,C组与A组比较差异具有显著性(P<0.05)。C组TMT完成时间和MMSE评分差值均低于A组B组,但各组内和组间比较差异无显著性(P>0.05)。结论:深度麻醉对老年腹腔镜腹部手术患者早期术后认知功能影响较小。

Objective： To compare the effect of different sedation depth of intravenous anesthesia on postoperative cognitive function in elderly patients undergoing laparoscopic abdominal surgery. Methods： 90 elderly patients would undergo abdominal surgery from March 2014 to March 2015 were chosen and randomly divided into three groups（A, B, C, 30 cases in each group by different depth combined intravenous and inhalation anesthesia）. The concentration of sevoflurane and remifentanil infusion rate was adjusted according to the BIS index, with group A maintains the BIS value levels 51-60, group B maintains the BIS value 41-50 and group C maintains the BIS value 31-40. In preoperative and day 1 after operation 1D on The cognitive function of patients was evaluated 1d before surgery and 1 d after the surgery. Results： There was no significant difference between the TMT completion time and MMSE score in group A 1d before anesthetization（P〈0.05）. The incidence rate of decline of postoperative 24 h cognitive function of group A was 30.0%, and for group B and C, the rate was 23.33% and 16.67%, respectively. The difference between the group C and the group A was significant（P〈0.05）. The TMT completion time and MMSE score in C group were both lower than that in group A and B, but there was no significant difference in or among the groups（P〈0.05）. Conclusion： Deep anesthesia has little influence on the cognitive function of elderly patients with laparoscopic abdominal surgery in early stage.