CAJ | 학술논문

目的：评价全凭静脉靶控输注麻醉不同的镇静深度对妇科腹腔镜术后认知功能的影响。方法择期妇科腹腔镜手术患者90例，年龄18～60岁，BMI 19～30 kg/m2，ASAⅠ或Ⅱ级。采用随机数字表法，将患者分为3组，每组30例。术中采用丙泊酚和瑞芬太尼靶控输注（TCI），间断静脉注射罗库溴铵维持麻醉，调控瑞芬太尼和丙泊酚血药浓度维持BIS值水平，Ⅰ组：30＜BIS值≤40，Ⅱ组：40＜BIS值≤50，Ⅲ组：50＜BIS值≤60。麻醉前1 d及术后1 d，记录简易精神状态量表（MMSE）评分及连线试验（TMT）完成时间。结果3组患者麻醉前1 d和术后1 d MMSE评分均＞24分，组内及组间比较差异均无统计学意义（P>0.05）。与麻醉前1 d相比，Ⅰ组和Ⅱ组患者术后1 d TMT完成时间缩短，Ⅲ组延长（P﹤0.05）；其中Ⅱ组和Ⅲ组术后1 d时TMT完成时间差异无统计学意义（P>0.05），与Ⅱ组和Ⅲ组比较，Ⅰ组术后1 d TMT完成时间显著缩短（P﹤0.05）。结论全凭静脉靶控输注丙泊酚-瑞芬太尼，麻醉维持30＜BIS值≤40镇静深度对妇科腹腔镜术后认知功能影响较小。
목적：평개전빙정맥파공수주마취불동적진정심도대부과복강경술후인지공능적영향。방법택기부과복강경수술환자90례，년령18～60세，BMI 19～30 kg/m2，ASAⅠ혹Ⅱ급。채용수궤수자표법，장환자분위3조，매조30례。술중채용병박분화서분태니파공수주（TCI），간단정맥주사라고추안유지마취，조공서분태니화병박분혈약농도유지BIS치수평，Ⅰ조：30＜BIS치≤40，Ⅱ조：40＜BIS치≤50，Ⅲ조：50＜BIS치≤60。마취전1 d급술후1 d，기록간역정신상태량표（MMSE）평분급련선시험（TMT）완성시간。결과3조환자마취전1 d화술후1 d MMSE평분균＞24분，조내급조간비교차이균무통계학의의（P>0.05）。여마취전1 d상비，Ⅰ조화Ⅱ조환자술후1 d TMT완성시간축단，Ⅲ조연장（P﹤0.05）；기중Ⅱ조화Ⅲ조술후1 d시TMT완성시간차이무통계학의의（P>0.05），여Ⅱ조화Ⅲ조비교，Ⅰ조술후1 d TMT완성시간현저축단（P﹤0.05）。결론전빙정맥파공수주병박분-서분태니，마취유지30＜BIS치≤40진정심도대부과복강경술후인지공능영향교소。
Objective To investigate the effects of different depths of sedation during total intravenous TCI anes-thesia on postoperative cognitive function in patients undergoing gynecological laparoscopic surgery. Methods Ninety ASAⅠorⅡpatients, aged 18~60 years, with a body mass index (BMI) of 19~30 kg/m2, scheduled for elective gynecolog-ical laparoscopic operation, were randomly divided into 3 groups (n=30 in each). Anesthesia was maintained with intra-venous infusion of TCI propofol and remifentanil, intermittent iv boluses of rocuronium. The infusion concentration of propofol and remifentanil was adjusted to maintain BIS value at 30﹤BIS value≤40 in group Ⅰ, 40﹤BIS value≤50 in group Ⅱ and 50﹤BIS value≤60 in group Ⅲ respectively. Cognitive function was assessed using the Mini-Mental State Examination (MMSE) and Trail-Making Test at 1 d before anesthesia and 1 d after surgery. Results MMSE scores were> 24 sores at 1 d before anesthesia and 1 d after surgery in all three groups, and there was no significant difference be-tween the two time points and among three groups (P>0.05). Compared with that before anesthesia, TMT completion time was shorter at 1 d after surgery in groups ⅠandⅡ, while prolonged in groupⅢ(P<0.05). TMT completion time was not significantly different at 1 d after surgery between groups Ⅱ and Ⅲ. Compared with groups Ⅱ and Ⅲ, the TMT comple-tion time was significantly different at 1 d after surgery in groupⅠ (P< 0.05). Conclusion The depth of sedation, 30﹤BIS value≤40, under total intravenous TCI anesthesia has milder influence on postoperative cognitive function.