不同剂量麝香复方液静滴对老年人全麻术后早期轻度认知障碍发生的比较

Comparison of different doses of musk compound solution in the early stage of mild cognitive impairment in elderly patients after general anesthesia

目的观察手术前静滴不同剂量复方麝香注射液对老年患者全麻术后早期轻度认知障碍(MCI)发生的影响。方法选择下肢与下腹部手术全麻患者120例(ASAⅠ-Ⅱ级),将其随机分为4组,组Ⅰ(n=30,对照),采用质量浓度为9 g/L的生理盐水100 m L静脉滴注;组II(n=30):应用低剂量复方麝香注射液(0.1m L/kg,加入质量浓度为9 g/L的生理盐水100 m L)手术开始前0.5 h静脉滴注,其速率为200 m L/h;组Ⅲ(n=30):应用中剂量复方麝香注射液(0.2 m L/kg),药物配伍、治疗时间和注射速度与组Ⅱ相同;组Ⅳ(n=30):高剂量复方麝香注射液(0.3 m L/kg),用药方法同组Ⅱ。各组术前用药、麻醉诱导、术中麻醉深度、麻醉苏醒等用药与方法相同;观察各组患者术前、术后第1天、3天、7天的CCSE、FAQ、MMSE评分等。结果 4组患者手术时间、麻醉时间、术中出血量、苏醒时间基本相同(P>0.05),4组手术后第1天、3天及7天CCSE、FAQ、MMSE认知功能评分均减少,组Ⅱ、组Ⅲ、组Ⅳ下降的变化幅度较小,得分高于组Ⅰ(P<0.05),组Ⅱ、组Ⅲ、组Ⅳ组间比较差异无统计学意义(P﹥0.05);术后第1天、3天、7天MCI发生率,组Ⅰ分别为66.7%、33.3%和16.7%;组Ⅱ为50.0%、16.7%和6.7%;组Ⅲ为50.0%、16.7%和6.7%。组Ⅳ为46.7%、20.0%和10.0%,用药组比组Ⅰ降低(P<0.05),但组Ⅱ、组Ⅲ、组Ⅳ之间无明显差异(P﹥0.05);4组术后不良反应组间比较差异无统计学意义。结论术前静脉滴注复方麝香注射液0.1 m L/kg可有效降低老年患者全麻术后MCI的发生,增加麝香注射液剂量(0.2 m L/kg、0.3 m L/kg)对于老年手术患者MCI未见增效作用,临床选用静滴的剂量0.1m L/kg即可。

Objective To observe the effect of different doses of compound musk injection before operation on early mild cognitive impairment （MCI） in elderly patients after general anesthesia. Methods We selected 120 cases of lower limb and lower abdominal surgery general anesthesia （ ASA level Ⅰ - Ⅱ ）, and divided them randomly into 4 groups ： Group Ⅰ （ n =30, control） ： 0. 9% saline 100mL intravenous infusion; Group Ⅱ （n = 30） ： low dose compound musk injection （0. 1 mL/kg, add 0. 9% saline 100 mL）, 0. 5h before the start of surgery, intravenous drip, the rate was 200 mL/h; Group Ⅲ （n = 30） ： medium dose compound musk injection （0. 2 mL/kg）, the same as group Ⅱ in drug compatibility, treatment time and injection rate; Group Ⅳ （n =30） ： high dose compound musk injection （0. 3 mL/kg）, the same as group Ⅱ in drug compatibility, treatment time and injection rate. Each premedication, induction of anesthesia, anesthesia depth, intraoperatire awake and anesthesia medication were the same. And we observed each group about preoperative and postoperative CCSE, FAQ and MMSE （mini-mental state examination） score of the 1 st days, 3rd days and 7th days. Results In the 4 groups of patients, the operation time, anesthesia time, intraoperative blood loss, recovery time were basically the same （P 〉 0. 05） ; CCSE, FAQ, MMSE cognitive function scores of 4 groups were reduced after operation on the first day, the third day and the seventh day; group Ⅱ , group Ⅲ, group IV decreased slightly. The scores were higher than group Ⅰ（ P 〈0. 05 ）, and there were no significant differences between group Ⅱ, group Ⅲ and group 1V （ P 〉 0. 05 ） ; The incidence of MCI in first days, third day and seventh day after operation respectively was： group I 66.7%, 33.3% and 16. 7% ; group Ⅱ 50% , 16. 7% and 6.7% ; group Ⅲ 50%, 16. 7% and 6. 7% ; group Ⅳ 46. 7% , 20% and 10%. Those of the drug groups were lower than group Ⅰ （P 〈 0. 05）, but there was no significant difference between group Ⅱ, group Ⅲ and group Ⅳ （P 〉 0.05）. There were no significant differences in the 4 groups in postoperative adverse reactions. Conclusion Preoperative intravenous infusion of compound musk injection 0. 1 ml/kg, may effectively reduce the incidence of MCI in elderly patients after general anesthesia. Increasing musk injection dose （0. 2 ml/kg, 0. 3 ml/kg and 0. 4 mg/kg） was no synergistic effect on MCI in elderly patients, 0. 1 ml/kg is enough.