国际麻醉学与复苏杂志
國際痳醉學與複囌雜誌
국제마취학여복소잡지
INTERNATIONAL JOURNAL OF ANESTHESIOLOGY AND RESUSCITATION
2014年
9期
783-786,795
,共5页
老年患者%术后认知功能%脑氧饱和度%磷酸肌酸钠
老年患者%術後認知功能%腦氧飽和度%燐痠肌痠鈉
노년환자%술후인지공능%뇌양포화도%린산기산납
Geriatric patients%Postoperative cognition function%Regional cerebral saturation of oxygenation%Creatine phosphate disodium salt
目的 探讨围术期脑氧饱和度(regional cerebral saturation of oxygenation,rSO2)与全凭静脉应用磷酸肌酸钠麻醉下老年患者术后认知功能变化的关系,为临床麻醉提供指导. 方法 60例美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级,年龄＞60岁的患者,行择期腹部及下肢手术.以患者就诊顺序进行编号,按完全随机分组法分为3组:磷酸肌酸钠组1(C1组)、磷酸肌酸钠组2(C2组)和空白对照组(C组),每组20例.麻醉前均不用术前药,入室后给予阿托品0.5 mg,缓慢静脉注射异丙酚、芬太尼、顺式阿曲库铵快速诱导气管插管,机械通气,维持呼气末二氧化碳分压(expiration carbon dioxide pressure,PErCO2)在正常范围,监测术中的rSO2变化.术中采用靶控输注模式(target controlled infusion,TCI)泵入异丙酚(3μg)及静脉泵注瑞芬太尼(0.2μg·kg-1·min-1～0.4 μg·kg-1·min-1)维持麻醉,间断静脉注射顺式阿曲库铵(0.07 mg/kg～0.10 mg/kg)维持肌松.应用简易智力状态检查(mini-mental scale examination,MMSE)、连线测试及凹槽拼板测试来评定3组患者术前24 h及术后4、8、12、24 h的认知功能变化.结果 ①3组患者的一般情况比较差异无统计学意义(P＞0.05).②3组患者术前MMSE、连线测试及凹槽拼板测试评分差异无统计学意义(P＞0.05);与患者入室时MMSE比较,所有患者术后4、8、12 h的MMSE均明显降低(P＜0.05).3组患者连线测试与凹槽拼板测试实验的测试时间比较发现:术前测试时间与术后测试时间相比较,差异无统计学意义(P＞0.05),其中C1组和C2组患者任务完成的时间明显缩短(其中C2组要比C1组完成任务的时间更短些),C组患者完成任务的时间延长.术后认知功能变化比较,术后4h,发生认知功能变化的C组中患者有3例(15％),C2组中患者有1例(5％),C1组患者有2例(10％);术后8h,C组中患者有2例(10％),C1组中患者有1例(5％),C2组患者认知功能基本恢复;术后12h,仅C组患者中有1例(5％),C1组和C2组患者认知功能基本恢复;术后24 h,所有组患者的认知功能均恢复,所有进入研究的患者均未发生谵妄.③C2组和C1组患者术后认知测试评分均明显高于C组(P＜0.01),术中3组患者的rSO2水平差异无统计学意义(P＞0.05). 结论 磷酸肌酸钠在麻醉中的应用,能降低老年患者术后认知功能障碍的发生率,可能与其独特的神经保护、提供外源性能量、提高中枢对于缺血/缺氧的耐受力有关.
目的 探討圍術期腦氧飽和度(regional cerebral saturation of oxygenation,rSO2)與全憑靜脈應用燐痠肌痠鈉痳醉下老年患者術後認知功能變化的關繫,為臨床痳醉提供指導. 方法 60例美國痳醉醫師協會(ASA)分級Ⅰ～Ⅱ級,年齡＞60歲的患者,行擇期腹部及下肢手術.以患者就診順序進行編號,按完全隨機分組法分為3組:燐痠肌痠鈉組1(C1組)、燐痠肌痠鈉組2(C2組)和空白對照組(C組),每組20例.痳醉前均不用術前藥,入室後給予阿託品0.5 mg,緩慢靜脈註射異丙酚、芬太尼、順式阿麯庫銨快速誘導氣管插管,機械通氣,維持呼氣末二氧化碳分壓(expiration carbon dioxide pressure,PErCO2)在正常範圍,鑑測術中的rSO2變化.術中採用靶控輸註模式(target controlled infusion,TCI)泵入異丙酚(3μg)及靜脈泵註瑞芬太尼(0.2μg·kg-1·min-1～0.4 μg·kg-1·min-1)維持痳醉,間斷靜脈註射順式阿麯庫銨(0.07 mg/kg～0.10 mg/kg)維持肌鬆.應用簡易智力狀態檢查(mini-mental scale examination,MMSE)、連線測試及凹槽拼闆測試來評定3組患者術前24 h及術後4、8、12、24 h的認知功能變化.結果 ①3組患者的一般情況比較差異無統計學意義(P＞0.05).②3組患者術前MMSE、連線測試及凹槽拼闆測試評分差異無統計學意義(P＞0.05);與患者入室時MMSE比較,所有患者術後4、8、12 h的MMSE均明顯降低(P＜0.05).3組患者連線測試與凹槽拼闆測試實驗的測試時間比較髮現:術前測試時間與術後測試時間相比較,差異無統計學意義(P＞0.05),其中C1組和C2組患者任務完成的時間明顯縮短(其中C2組要比C1組完成任務的時間更短些),C組患者完成任務的時間延長.術後認知功能變化比較,術後4h,髮生認知功能變化的C組中患者有3例(15％),C2組中患者有1例(5％),C1組患者有2例(10％);術後8h,C組中患者有2例(10％),C1組中患者有1例(5％),C2組患者認知功能基本恢複;術後12h,僅C組患者中有1例(5％),C1組和C2組患者認知功能基本恢複;術後24 h,所有組患者的認知功能均恢複,所有進入研究的患者均未髮生譫妄.③C2組和C1組患者術後認知測試評分均明顯高于C組(P＜0.01),術中3組患者的rSO2水平差異無統計學意義(P＞0.05). 結論 燐痠肌痠鈉在痳醉中的應用,能降低老年患者術後認知功能障礙的髮生率,可能與其獨特的神經保護、提供外源性能量、提高中樞對于缺血/缺氧的耐受力有關.
목적 탐토위술기뇌양포화도(regional cerebral saturation of oxygenation,rSO2)여전빙정맥응용린산기산납마취하노년환자술후인지공능변화적관계,위림상마취제공지도. 방법 60례미국마취의사협회(ASA)분급Ⅰ～Ⅱ급,년령＞60세적환자,행택기복부급하지수술.이환자취진순서진행편호,안완전수궤분조법분위3조:린산기산납조1(C1조)、린산기산납조2(C2조)화공백대조조(C조),매조20례.마취전균불용술전약,입실후급여아탁품0.5 mg,완만정맥주사이병분、분태니、순식아곡고안쾌속유도기관삽관,궤계통기,유지호기말이양화탄분압(expiration carbon dioxide pressure,PErCO2)재정상범위,감측술중적rSO2변화.술중채용파공수주모식(target controlled infusion,TCI)빙입이병분(3μg)급정맥빙주서분태니(0.2μg·kg-1·min-1～0.4 μg·kg-1·min-1)유지마취,간단정맥주사순식아곡고안(0.07 mg/kg～0.10 mg/kg)유지기송.응용간역지력상태검사(mini-mental scale examination,MMSE)、련선측시급요조병판측시래평정3조환자술전24 h급술후4、8、12、24 h적인지공능변화.결과 ①3조환자적일반정황비교차이무통계학의의(P＞0.05).②3조환자술전MMSE、련선측시급요조병판측시평분차이무통계학의의(P＞0.05);여환자입실시MMSE비교,소유환자술후4、8、12 h적MMSE균명현강저(P＜0.05).3조환자련선측시여요조병판측시실험적측시시간비교발현:술전측시시간여술후측시시간상비교,차이무통계학의의(P＞0.05),기중C1조화C2조환자임무완성적시간명현축단(기중C2조요비C1조완성임무적시간경단사),C조환자완성임무적시간연장.술후인지공능변화비교,술후4h,발생인지공능변화적C조중환자유3례(15％),C2조중환자유1례(5％),C1조환자유2례(10％);술후8h,C조중환자유2례(10％),C1조중환자유1례(5％),C2조환자인지공능기본회복;술후12h,부C조환자중유1례(5％),C1조화C2조환자인지공능기본회복;술후24 h,소유조환자적인지공능균회복,소유진입연구적환자균미발생섬망.③C2조화C1조환자술후인지측시평분균명현고우C조(P＜0.01),술중3조환자적rSO2수평차이무통계학의의(P＞0.05). 결론 린산기산납재마취중적응용,능강저노년환자술후인지공능장애적발생솔,가능여기독특적신경보호、제공외원성능량、제고중추대우결혈/결양적내수력유관.
Objective To discuss the relationship of perioperative regional cerebral saturation of oxygenation (rSO2) and postoperative cognition function alteration of geriatric patients under intravenous anesthesia using creatine phosphate disodium salt,and to establish the clinical practical guides.Methods Sixty ASA Ⅰ-Ⅱ patients,aged＞60 y scheduled for selective abdominal surgeries or surgeries on lower limb were enrolled in this study.We used a completely randomized grouping design for this study and the 20 patients were divided into 3 groups:creatine phosphate disodium salt group 1 (C1),creatine phosphate disodium salt group 2 (C2),Control group (C).All patients were not premeditated with atropine 0.5 mg until entering the operation room.Anesthesia was induced with intravenous infusion of propofol,fentanyl and cisatracurium slowly,The anesthesia was maintained by intravenous propofol infusion in target controlled infusion target controlled infusion (TCI) (3 μg) and remifentanyl (0.2 μg·kg-1·min-1-0.4 μg·kg-1·min-1) infusion,intravenous bolus cisatracurium (0.07 mg/kg-0.10 mg/kg).After tracheal intubation,all patients were mechanically ventilated with expiration carbon dioxide pressure (PERCO2) at normal scale.The rSO2 was continuously monitored and recorded in operations.The mini-mental state examination (MMSE),trail-making test and grooved pegboard test were adopted to access cognitive function 24 h before surgery and 4,8,12,24 h after surgery.Results ① There were no significantly difference of general status among the three groups(P＞0.05).② The scales of MMSE,trail-making test and grooved pegboard test were not different 24 h before operations among three groups (P＞0.05).Compared with scales of MMSE before operation,4,8,12 h after operation in all patients were significantly lower (P＜0.05).Three groups of patients trail-making test and the grooved pegboard test time comparison experiment found:there were no difference between preoperative and postoperative testing time (P＞0.05),which time of patients in group C2 completed the task significantly shorter than group C1,the control group of patients needed more time to complete the task.Comparison of postoperative cognitive function changes after 4 h,cognitive function changes occurred in the control group of patients with 3 patients (15％),creatine phosphate (C2) of patients in group 1 patient (5％),creatine phosphate sodium (C1) patients,2 patients (10％).After 8 h,patients in the control group 2 patients (10％),creatine phosphate (C1) patients in group 1 patients (5％),phosphoric acid muscle sodium (C2) cognitive function in patients recovered.Postoperative 12 h,patients in the control group only one case (5％),creatine phosphate groups (group C1 and C2) cognitive function in patients recovered,after 24 h,cognitive function of all patients recovered,the delirium did not occur in all patients entered the study.(③ The scales of cognitive tests were higher in group C2 and group C1 than C (P＜0.01).The numbers of rSO2 in the three groups were identical (P＞0.05).Conclusions Creatine phosphate disodium salt can reduce the occurrence of postoperative cognitive dysfunction in geriatric patients combined the intravenous and inhalational anesthesia.The results may relate to its neural protection effects,unique natural energy supply and increasing central neural system tolerance of ischemia and hypoxia.
