静脉输注亚甲蓝对全身麻醉恢复及术后认知功能的影响

Effect of intravenous methylene blue on the recovery of general anesthesia and postoperative cognitive function

目的探讨静脉输注亚甲蓝在全甲状腺切除术中对全身麻醉恢复及术后认知功能的影响。方法选择2015年7至12月于首都医科大学附属北京同仁医院全麻下因甲状腺癌行全甲状腺切除术患者40例,年龄18~65岁,美国麻醉医师协会(ASA)分级Ⅰ~Ⅱ级。采用随机数字表法将患者分为两组(n=20):亚甲蓝组(M组)与对照组(C组)。麻醉方法为靶控输注丙泊酚、静脉注射舒芬太尼和顺阿曲库铵诱导后行气管插管及机械通气,维持呼气末二氧化碳分压(PETCO2)35~40 mmHg。M组为手术开始后30 min内,将亚甲蓝以3 mg/kg剂量溶于5%葡萄糖250 ml,静脉输注完毕;C组则输注5%葡萄糖250 ml。术中调整靶控丙泊酚血浆浓度,将脑电双频指数(BIS)值控制在40~60,静脉输注瑞芬太尼,间断推注顺阿曲库铵维持麻醉。记录苏醒时间和苏醒时丙泊酚血浆浓度,记录术后30 min内昏迷恢复量表(CRS-R)评分。分别于术前1 d、术后1 d及术后3 d时,采用数字符号转换测验(DSST)、数字广度测试(DST)、连线测试A(TMT-A)和连线测试B(TMT-B)评估患者认知功能。结果M组与C组苏醒时间分别为(9.5±2.1)、(7.0±2.0)s,苏醒时丙泊酚血浆浓度分别为(1.2±0.2)、(1.7±0.2)μg/ml,与C组相比,M组苏醒时间延长,苏醒时丙泊酚血浆浓度低,差异均有统计学意义(均P<0.05)。苏醒后10 min内,M组CRS-R评分更低,差异有统计学意义(P<0.05),20 min时CRS-R评分差异无统计学意义(P>0.05)。两组术后1 d及3 d认知功能评分差异均无统计学意义(均P>0.05)。结论静脉输注亚甲蓝可短暂影响全身麻醉恢复,但对术后认知功能无明显影响。

Objective To investigate the effect of intravenous infusion of methylene blue on the recovery of general anesthesia and postoperative cognitive function in total thyroidectomy.Methods Forty patients scheduled for total thyroidectomy with general anesthesia from July,2015 to December,2015,aged 18-65 yr,of American Society of Anesthesiologists physical statusⅠorⅡ,were divided into two groups(n=20 each)using a random number table method:methylene blue infusion group(group M)and control group(group C).General anesthesia was induced with target-controlled infusion of propofol,and intravenously injecting sufentanil and cisatracurium besylate.The patients were mechanically ventilated after tracheal intubation.For the patients in group M,methylene blue was dissolved in 5%glucose 250 ml at 3 mg/kg dose and was intravenously infused within 30 min at the beginning of the operation.The patients in group C received 5%glucose 250 ml.The plasma concentration of propofol was adjusted to control the Bispectral Index(BIS)value between 40-60.Awakening time and plasma concentration of propofol at awakening were recorded.Coma recovery scale(CRS-R)score was recorded 30 min postoperatively.Digit Symbol Substitution Test(DSST),Digital Span Test(DST),Train Making Test A and B(TMT-A and TMT-B)were used to evaluate the cognitive function of patients at 1 day before surgery,1 and 3 days after surgery.Results The awakening time of group M and group C were(9.5±2.1)s and(7.0±2.0)s,respectively.The plasma concentration of propofol at awakening in M group and group C were(1.2±0.2)μg/ml and(1.7±0.2)μg/ml,respectively.Compared with group C,the awakening time was significantly prolonged,the plasma concentration of propofol at awakening was significantly decreased in group M(both P<0.05).Within 10 min of awakening,the CRS-R score of group M was significantly lower than that of group C(P<0.05),while there was no significant difference of CRS-R score between two groups at 20 min after awakening(P>0.05).There was no significant difference of cognitive function scores between group C and group M at 1 day and 3 day after operations(all P>0.05).Conclusion Intravenous methylene blue may briefly affect the recovery of general anesthesia,but has no significant effect on postoperative cognitive function.