氟马西尼对全麻肝叶切除术患者促醒作用及恢复期脑电双频指数、认知功能的影响观察

Revival effects of flumazenil in patients undergoing hepatic lobectomy under general anesthesia and the influence on convalescent bispectral index and cognitive function

目的观察氟马西尼对全麻肝叶切除术患者促醒作用及恢复期脑电双频指数(BIS)、认知功能的影响。方法选取50例全麻肝叶切除术患者,根据是否使用氟马西尼分为氟马西尼组(n=25)和非氟马西尼组(n=25),两组均采取瑞芬太尼复合丙泊酚靶控输注(TCI)全麻,术中维持BIS在40~60之间。术毕入麻醉苏醒室即刻,氟马西尼组给予氟马西尼静脉推注,非氟马西尼组给予等体积生理盐水静脉推注。记录两组术后复苏时间指标及入苏醒室后不同时间点BIS值变化,并分别于术前1 d及术后1 d、3 d、5 d采用简易智能精神检查量表(MMSE)评价患者认知功能。结果氟马西尼组较非氟马西尼组术后自主呼吸恢复时间、指令下睁眼时间、指令下握拳时间、拔管时间及回忆起出生日期时间均明显缩短(P<0.05)。氟马西尼组BIS值从进入麻醉苏醒室后4 min开始明显增高(P<0.05),非氟马西尼组BIS值从进入麻醉苏醒室后6 min开始明显增高(P<0.05)。氟马西尼组进入麻醉苏醒室4 min、6 min、8 min、10 min、12 min、14 min、16 min的BIS值均明显高于非氟马西尼组(P<0.05)。在术后1 d、3 d、5 d等时间上,氟马西尼组MMSE评分均明显高于非氟马西尼组,差异有统计学意义(P<0.05)。结论氟马西尼可促进全麻肝叶切除术患者术后苏醒,改善患者认知功能。

Objective To observe the revival effects of flumazenil in patients undergoing hepatic lobectomy under general anesthesia and the influence on convalescent bispectral index（BIS） and cognitive function. Methods Fifty patients undergoing hepatic lobectomy under general anesthesia were selected. They were divided into flumazenil group（n=25）and non flumazenil group（n=25）according to the use of flumazenil. Both groups were given remifentanil combined with propofol target-controlled infusion（TCI）general anesthesia,and BIS was maintained between 40 to 60. At the end of the operation,the flumazenil group was given intravenous infusion of flumazenil,and the non flumazenil group was given intravenous injection of equal volume of normal saline. Postoperative recovery time and changes of BIS values at different time points after recovery in the two groups were recorded. The cognitive function of patients was evaluated by the mini mental state examination（MMSE）before operation and at 1 d,3 d and5 d after operation. Results The postoperative spontaneous breathing recovery time,eye opening time under the instruction,fist making time under the instruction,extubation time and time of recalling the birth date of the flumazenil group were significantly shorter than those of the non flumazenil group（P〈0.05）. The BIS value of the flumazenil group increased significantly at 4 min after entering the anesthesia recovery room（P〈0.05）,while the BIS value of the non flumazenil group increased significantly at 6 min after entering the anesthesia recovery room（P〈0.05）. The BIS values the flumazenil group at 4 min,6 min,8 min,10 min,12 min,14 min and 16 min after entering the anesthesia recovery room were significantly higher than those of the non flumazenil group（P〈0.05）. MMSE scores of the flumazenil group at 1 d,3 d and 5 d after operation were significantly higher than those of the non flumazenil group（P〈0.05）. Conclusion Flumazenil can promote the recovery of patients undergoing hepatic lobectomy from general anesthesia and improve their cognitive function.