中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2013年
2期
175-177
,共3页
麻醉,吸入%麻醉,静脉%深度镇静%认知障碍%手术后并发症
痳醉,吸入%痳醉,靜脈%深度鎮靜%認知障礙%手術後併髮癥
마취,흡입%마취,정맥%심도진정%인지장애%수술후병발증
Anesthesia,inhalation%Anesthesia,intravenous%Deep sedation%Cognition disorders%Postoperative complications
目的 评价静吸复合麻醉不同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20～ 64岁,BMI 19～ 30 kg/m2,ASA分级Ⅰ或Ⅱ级.采用随机数字表法,将患者分为3组(n=30).术中吸入七氟醚(呼气末浓度1.0％～1.5％)、静脉输注瑞芬太尼和间断静脉注射罗库溴铵维持麻醉,调控瑞芬太尼静脉输注速率维持BIS值水平,Ⅰ组:30＜ BIS值≤40、Ⅱ组:40＜ BIS值≤50和Ⅲ组:50＜ BIS值≤60.麻醉前1d及术后1d,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1d和术后1d 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ld相比,Ⅰ组和Ⅲ组患者术后1dTMT完成时间延长,Ⅱ组缩短(P＜0.05)；与Ⅰ组和Ⅲ组比较,Ⅱ组术后1 d TMT完成时间缩短(P＜0.05).结论 七氟醚-瑞芬太尼静吸复合麻醉维持40＜ BIS值≤50镇静深度对妇科腹腔镜术后认知功能影响较小.
目的 評價靜吸複閤痳醉不同鎮靜深度對婦科腹腔鏡術後認知功能的影響.方法 擇期婦科腹腔鏡手術患者90例,年齡20～ 64歲,BMI 19～ 30 kg/m2,ASA分級Ⅰ或Ⅱ級.採用隨機數字錶法,將患者分為3組(n=30).術中吸入七氟醚(呼氣末濃度1.0％～1.5％)、靜脈輸註瑞芬太尼和間斷靜脈註射囉庫溴銨維持痳醉,調控瑞芬太尼靜脈輸註速率維持BIS值水平,Ⅰ組:30＜ BIS值≤40、Ⅱ組:40＜ BIS值≤50和Ⅲ組:50＜ BIS值≤60.痳醉前1d及術後1d,記錄簡易精神狀態量錶(MMSE)評分及連線試驗(TMT)完成時間.結果 3組患者痳醉前1d和術後1d MMSE評分均＞24分,組內及組間比較差異均無統計學意義(P＞0.05).與痳醉前ld相比,Ⅰ組和Ⅲ組患者術後1dTMT完成時間延長,Ⅱ組縮短(P＜0.05)；與Ⅰ組和Ⅲ組比較,Ⅱ組術後1 d TMT完成時間縮短(P＜0.05).結論 七氟醚-瑞芬太尼靜吸複閤痳醉維持40＜ BIS值≤50鎮靜深度對婦科腹腔鏡術後認知功能影響較小.
목적 평개정흡복합마취불동진정심도대부과복강경술후인지공능적영향.방법 택기부과복강경수술환자90례,년령20～ 64세,BMI 19～ 30 kg/m2,ASA분급Ⅰ혹Ⅱ급.채용수궤수자표법,장환자분위3조(n=30).술중흡입칠불미(호기말농도1.0％～1.5％)、정맥수주서분태니화간단정맥주사라고추안유지마취,조공서분태니정맥수주속솔유지BIS치수평,Ⅰ조:30＜ BIS치≤40、Ⅱ조:40＜ BIS치≤50화Ⅲ조:50＜ BIS치≤60.마취전1d급술후1d,기록간역정신상태량표(MMSE)평분급련선시험(TMT)완성시간.결과 3조환자마취전1d화술후1d MMSE평분균＞24분,조내급조간비교차이균무통계학의의(P＞0.05).여마취전ld상비,Ⅰ조화Ⅲ조환자술후1dTMT완성시간연장,Ⅱ조축단(P＜0.05)；여Ⅰ조화Ⅲ조비교,Ⅱ조술후1 d TMT완성시간축단(P＜0.05).결론 칠불미-서분태니정흡복합마취유지40＜ BIS치≤50진정심도대부과복강경술후인지공능영향교소.
Objective To investigate the effects of different depths of sedation during combined intravenous-inhalational anesthesia on postoperative cognitive function in patients undergoing gynecological laparoscopic surgery.Methods Ninety ASA Ⅰ or Ⅱ patients,aged 20-64 yr,with a body mass index of 19-30 kg/m2,scheduled for elective gynecological laparoscopic operation,were randomly divided into 3 groups (n =30 each).Anesthesia was induced with midazolam,fentanyl,propofol and rocuronium.The patients were tracheal intubated and mechanically ventilated.Anesthesia was maintained with inhalation of sevoflurane (end-tidal concentration 1.0％-1.5 ％),iv infusion of remifentanil and intermittent iv boluses of rocuronium.The infusion rate of remifentanil was adjusted to maintain BIS value:30 ＜ BIS value ≤ 40 in group Ⅰ,40 BIS value ≤ 50 in group Ⅱ and 50 ＜ BIS value≤60 in group Ⅲ.Cognitive function was assessed using Mini-Mental State Examination (MMSE) and TrailMaking Test (TMT) at 1 d before anesthesia and 1 d after surgery.Results MMSE scores were ＞ 24 at 1 d before anesthesia and 1 d after surgery in all the three groups,and there was no significant difference within each group and among the three groups (P ＞ 0.05).Compared with the baseline value,TMT completion time was significantly prolonged at 1 d after surgery in groups Ⅰ and Ⅲ,while shortened in group Ⅱ (P ＜ 0.05).Compared with groups Ⅰ and Ⅲ,TMT completion time was significantly shortened at 1 d after surgery in group Ⅱ (P ＜0.05).Conclusion The depth of sedation,40 ＜ BIS value ≤ 50,during combined intravenous-inhalational anesthesia with sevoflurane and remifentanil has less influence on postoperative cognitive function in patients undergoing gynecological laparoscopic surgery.
