小儿扁桃体腺样体切除术在不同麻醉深度指数下行气管拔管对苏醒质量及认知功能的影响

Effect of the time to extubate in children with adenotonsillectomy on recovery of anaesthesia and postoperative cognitive dysfunction

目的探讨Narcotrend麻醉深度监测仪监测下不同麻醉深度指数时(NT值),拔除气管导管对小儿扁桃体腺样体切除术后苏醒质量及认知功能的影响。方法选择2019年1月—2020年8月在韶关市妇幼保健院行鼻内镜下低温射频腺样体消融术扁桃体切除术治疗的76例患儿作为研究对象,根据其术后无刺激反应拔管时的NT值自动纳入A、B、C 3组:A组NT值95~100(23例),B组NT值80~94(25例), C组NT值65~79(28例)。比较各组患儿术毕疼痛评分、苏醒时间、低氧血症等拔管后不良反应。分别于术前1 d,术后1 d、术后3 d和术后7 d,采用简易智能状态检查量表(Mini-Mental State Examination, MMSE)和蒙特利尔认知评估量表(Montreal Cognitive Assessment,MoCA)评估患儿的认知功能。结果 A组苏醒疼痛评分高于B、C组(P<0.05),B组拔管不良反应发生率低于A、C组(P<0.05),C组苏醒时间多于A、B组(P<0.05),差异均有统计学意义。各组患儿术后1、3和7 d的MMSE评分、MoCA评分较术前1 d均降低,但术后B组1 d和3 d的MMSE评分、MoCA评分高于A、C组(P<0.05),差异均有统计学意义。结论小儿扁桃体腺样体切除术后NT值在80~94之间时,拔除气管导管可有效提高患儿苏醒质量,改善患儿术后认知功能障碍。

Objective To investigate the effect of the time to extubate in children with adenotonsillectomy on recovery of anaesthesia and postoperative cognitive dysfunction under Narcotrend monitoring.Methods 76 children who recieved low temperature plasma adenotonsillectomy in Shaoguan Maternal and Child Health Care Hospital from January 2019 to September 2020 were selected.According to the Narcotrend(NT) value during extubation, they were divided into three groups: group A [NT maintained at 95-100]with 23 cases, group B(NT maintained at 80-94) with 25 cases and group C(NT maintained at 65-79) with 28 cases. The differences in CHIPPS scores, anesthesia recovery time, and the incidence of respiratory depression and retrolingual drop, etc.between the three groups were compared. The MMSE scale and MoCA scale were used to evaluate the cognitive function of the patients on preoperative 1 day, postoperative 1 day, postoperative 3 day and postoperative 7 day.Results Anesthesia recovery time in group C was significantly higher than that in group A and group B, the CHIPPS scores in group A were significantly higher than those in group B and group C, and the incidence of adverse reactions(ADRs) to extubation in group A and group C was significantly higher than that in group B, with statistically significant differences(P< 0. 05). There were differences in MMSE and MoCA scores among the three groups. On the 1 st and 3 rd days after operation, the MMSE and MoCA scores in group B were significantly higher than those in group A and group C(P< 0. 05).Conclusion Maintaining the NT value between 80 and 94 after operation can reduce the ADRs and cognitive impairment in the process of tracheal catheter extubation after adenotonsillectomy.