不同麻醉方法对全麻患儿术后认知功能的影响

Effects of different anesthesia methods on postoperative cognitive function of children under general anesthesia

目的:研究不同麻醉方法对全麻状态下行扁桃体联合腺样体切除术的患儿术后认知功能的影响。方法:选取本院2018年1月~2020年6月进行扁桃体联合腺样体切除全麻手术的患儿80例,随机分为吸入麻醉组和全凭静脉组,每组40例。吸入麻醉组患儿采用七氟烷吸入麻醉,全屏静脉组患儿采用瑞芬太尼和丙泊酚全屏静脉麻醉。观察统计术前24 h,术后6 h,术后24 h两组患儿BSID Ⅲ评分,并统计两组POCD发生率。结果:术前24 h,两组患儿BSID Ⅲ评分差异无统计学意义;术后6 h,与术前24 h比较,两组BSID Ⅲ评分均明显下降;术后24 h,与术前24 h比较,吸入麻醉组BSID Ⅲ评分均明显降低,全屏静脉组"认知""身体动作"评分虽低于术前24 h,但差异无统计学意义,其他领域评分均明显低于术前24 h。组间比较,术后6 h、术后24 h全屏静脉组患儿BSID Ⅲ评分均明显高于吸入麻醉组,且差异具有统计学意义。术前两组患儿POCD发生率均为0.00%。术后6 h,全屏静脉组患儿POCD发生率(15.00%)明显低于吸入麻醉组(35.00%),且差异具有统计学意义。术后24 h,全屏静脉组患儿POCD发生率(2.50%)低于吸入麻醉组(12.50%),但差异无统计学意义。结论:两种麻醉方式均安全可取,全凭静脉麻醉对患儿中枢神经系统损伤小,术后认知功能恢复迅速,更利于恢复,具有临床推广价值。

Objective To study the effect of different anesthesia methods on postoperative cognitive function of children undergoing tonsillectomy combined with adenoidectomy under general anesthesia.Methods 80 children undergoing tonsillectomy combined with adenoidectomy in our hospital from January 2018 to June 2020 were randomly divided into inhalation anesthesia group and total intravenous group,40 cases in each group.Sevoflurane inhalation anesthesia was used in the inhalation anesthesia group,while remifentanil and propofol were used in the full screen intravenous anesthesia group.Bsid Ⅲ scores were observed 24 hours before operation,6 hours after operation and 24 hours after operation,and the incidence of POCD was also calculated.Results There was no significant difference in BSID Ⅲ score between the two groups at 24 h before operation;BSID Ⅲ score of both groups decreased significantly at 6 h after operation compared with 24 h before operation;BSID Ⅲ score of inhalation anesthesia group was significantly lower than that of 24 h before operation,while the scores of cognition and body movement in full screen venous group were lower than those in preoperative 24 h.But the difference was not statistically significant,the scores in other fields were significantly lower than those 24 h before operation.The BSID Ⅲ score of the full screen intravenous group was significantly higher than that of the inhalation anesthesia group at 6 h and 24 h after operation,and the difference was statistically significant.The incidence of POCD in both groups was 0.00%.At 6 h after operation,the incidence of POCD in full screen intravenous group (15.00%) was significantly lower than that in inhalation anesthesia group (35.00%),and the difference was statistically significant.At 24 h after operation,the incidence of POCD in full screen intravenous group (2.50%) was lower than that in inhalation anesthesia group (12.50%),but the difference was not statistically significant.Conclusion The two anesthesia methods are safe and feasible.Total intravenous anesthesia has little damage to the central nervous system of children,and the postoperative cognitive function recovers quickly,which is more conducive to recovery,and has the value of clinical promotion.