CAJ | 학술논문

目的比较不同全麻对非心脏手术患者术后认知功能的影响.方法拟行非心脏手术患者1000例,年龄18～60岁,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将患者随机分为5组(n=200):异氟醚+异丙酚+芬太尼组(IPF组)、异氟醚+瑞芬太尼组(IR组)、七氟醚+异丙酚+芬太尼组(SPF组)、七氟醚+瑞芬太尼组(SR组)和异丙酚+瑞芬太尼组(PR组).麻醉维持:IPF组和SPF组分别吸入1.68%异氟醚或1.71%七氟醚,TCI异丙酚,血浆靶浓度2～5 μg/ml,间断静脉注射芬太尼;IR组、SR组和PR组分别吸入1.68%异氟醚或1.71%七氟醚或TCI异丙酚,血浆靶浓度2～5 μg/ml,TCI瑞芬太尼,血浆靶浓度2～6 ng/ml.选择同期住院的非手术患者200例作为对照组(C组).于术前1 d、出麻醉恢复室时、术后1和3 d时,采用MMSE量表进行认知功能评分.于出麻醉恢复室时、术后1和3 d时,采用Z计分法评判认知功能障碍.结果与C组比较,IPF组、IR组、SPF组、SR组和PR组出麻醉恢复室时MMSE评分降低,出麻醉恢复室时及术后1 d时认知功能障碍的发生率升高(P＜0.05);与IPF组、IR组、SPF组和PR组比较,SR组术后认知功能障碍的发生率降低(P＜0.05).结论七氟醚复合瑞芬太尼麻醉对非心脏手术患者术后认知功能的影响较小.
목적 비교불동전마대비심장수술환자술후인지공능적영향.방법 의행비심장수술환자1000례,년령18～60세,ASA분급Ⅰ혹Ⅱ급,채용수궤수자표법,장환자수궤분위5조(n=200):이불미+이병분+분태니조(IPF조)、이불미+서분태니조(IR조)、칠불미+이병분+분태니조(SPF조)、칠불미+서분태니조(SR조)화이병분+서분태니조(PR조).마취유지:IPF조화SPF조분별흡입1.68%이불미혹1.71%칠불미,TCI이병분,혈장파농도2～5 μg/ml,간단정맥주사분태니;IR조、SR조화PR조분별흡입1.68%이불미혹1.71%칠불미혹TCI이병분,혈장파농도2～5 μg/ml,TCI서분태니,혈장파농도2～6 ng/ml.선택동기주원적비수술환자200례작위대조조(C조).우술전1 d、출마취회복실시、술후1화3 d시,채용MMSE량표진행인지공능평분.우출마취회복실시、술후1화3 d시,채용Z계분법평판인지공능장애.결과 여C조비교,IPF조、IR조、SPF조、SR조화PR조출마취회복실시MMSE평분강저,출마취회복실시급술후1 d시인지공능장애적발생솔승고(P＜0.05);여IPF조、IR조、SPF조화PR조비교,SR조술후인지공능장애적발생솔강저(P＜0.05).결론 칠불미복합서분태니마취대비심장수술환자술후인지공능적영향교소.
Objective To compare the effects of methods of general anesthesia on postoperative cognitive function in patients undergoing non-cardiac surgery. Methods One thousand ASA Ⅰ or Ⅱ patients, aged 18-60 yr, undergoing non-cardiac surgery were randomly divided into 5 groups ( n = 200 each) : isoflurane + propofol + fentanyl group (group IPF); isoflurane + remifentanil group (group IR) ; sevoflurane + propofol + fentanyl group (group SPF) ; sevoflurane + remifentanil group (group SR) ; propofol + remifentanil group (group PR) . Two hundred non-operative patients served as control group (group C) . In groups IPF and SPF, anesthesia was maintained with inhalation of 1.68% isoflurane or 1.71 % sevoflurane, TCI of propofol with the target plasma concentration of 2-5 μg/ml, and intermittent iv boluses of fentanyl. In groups IR, SR and PR, anesthesia was maintained with inhalation of 1.68% isoflurane or 1.71% sevoflurane, or TCI of propofol with the target plasma concentration of 2- 5 μg/ml, and TCI of remifentanil with the target plasma concentration of 2-6 ng/ml. The patients' cognitive function was assessed using mini-mental state examination (MMSE) at 1 d before operation, while leaving postanesthesia care unit (PACU) , and at 1 and 3 d after operation. The Z score was used to identify the cognitive dysfunction as recommended by Moller while leaving PACU, and at 1 and 3 d after operation. Results Compared with group C, the MMSE score was significantly decreased while leaving PACU , and the incidence of cognitive dysfunction increased while leaving PACU and at 1 d after operation in the other groups ( P ＜ 0.05). Compared with groups IPF,IR,SPF and PR, the incidence of cognitive dysfunction was significantly increased in group SR ( P ＜ 0.05) . Conclusion General anesthesia with sevoflurane combined remifentanil exerts less effect on the postoperative cognitive function in patients undergoing non-cardiac surgery.