不同麻醉方案对冠状动脉搭桥术后MMSE评分及Ramsay评分的影响

Effects of different anesthesia agents on MMSE scores and Ramsay scores in patients undergoing off-pump coronary artery bypass grafting surgery

目的探讨静脉麻醉与不同浓度七氟烷吸入麻醉对冠状动脉搭桥术患者术后MMSE评分及Ramsay镇静评分的影响。方法选取非体外循环冠脉搭桥手术患者90例,随机分为舒芬太尼+丙泊酚组(A组),舒芬太尼+丙泊酚+0.5 MAC七氟烷组(B组),舒芬太尼+丙泊酚+1.0 MAC七氟烷组(C组),每组30例。记录各组患者术前1 d、术后1、3和5 d MMSE评分及麻醉前、麻醉后6、12和24 h Ramsay评分。结果与术前1 d比较,各组在术后1和3 d MMSE评分显著降低(P<0.05)。术后5 d差异无统计学意义,与A组比较B、C组术后1和3 d显著升高,差异有统计学意义,术后5 d差异无统计学意义。Ramsay镇静评分比较与麻醉前比较,各组在麻醉后6和12 h时Ramsay评分显著升高(P<0.05),但组间比较无统计学意义。结论丙泊酚与七氟烷麻醉均可达到确切镇静效果且七氟烷可降低冠状动脉搭桥术患者POCD发生风险,但长期效果还有待进一步研究。

AIM To investigate the effects of intravenous anesthesia using different concentrations of sevoflurane on MMSE scores and Ramsay sedation scores in patients undergoing off-pump coronary artery bypass surgery. METHODS 90 patients ( ASA Ⅱ or Ⅲ, aged 56 to 73 years) undergoing off-pump coronary artery bypass grafting surgery were randomly divided into three groups ( n = 30, each group): sufentanil + propofol group ( Group A ), sufentanil + propofol + 0. 5 MAC sevoflurane group ( Group B ) and sufentanil and propofol + 1.0 MAC sevoflurane group ( Group C ). MMSE scores were recorded, respectively, 1 day before and 1, 3 and 5 days after operation. Ramsay scores were recorded, respectively, before and 6, 12, and 24 hours after anesthesia. RESULTS Compared with those l)efore the operation, MMSE scores were significantly lower at 1 and 3 days after surgery in all three groups (P < 0. 05). Compared with those in Group A, MMSE scores in Group B and Group C were significantly higher 1 and 3 days after surgery. Ramsay scores were significantly higher 6 and 12 hours after operation in all three groups (P < 0. 05 ). CONCLUSION Anesthesia with propofol or sevoflurane achieves good sedation, but sevoflurane lowers the risks of postoperative cognitive dysfunction in patients undergoing off-pump coronary artery bypass grafting surgery.