CAJ | 학술논문

目的比较丙泊酚或依托咪酯麻醉后对幼儿近、远期认知功能的影响.方法 100例1~3岁拟行择期腹腔镜下疝修补术患儿,随机分为丙泊酚麻醉组( A组)、依托咪酯麻醉组( B组)各50例;50例同年龄段健康幼儿作对照组( C组). A、B组麻醉诱导分别给予丙泊酚1 ~3 mg·kg-1、依托咪酯0.1 ~0.4 mg·kg-1 ,在此基础上均给予芬太尼( 1~2 ) ×10 -3 mg·kg-1、罗库溴铵0.6~1.2 mg·kg-1 ,均于手术开始前给予芬太尼2 ×10 -3 mg·kg-1进行麻醉维持.A、B组均于术前1 d、术后3 d和3个月用贝莉婴幼儿认知量表-Ⅲ( BSID-Ⅲ)按月龄进行相应年龄段的认知功能评估,C组同期进行,比较各组3个时期认知功能的改变. 结果与术前 1 d 比较,A、B 组术后 3 d 评分均下降(P<0.05),术后认知功能障碍患儿分别为10例(20.0%)、9例(18.0%),术后3个月认知功能评分及术后认知功能障碍发生率差异无统计学意义( P>0.05 );A、B组比较,术后3 d、术后3个月认知评分及术后认知功能障碍发生率差异无统计学意义( P>0.05).结论丙泊酚或依托咪酯麻醉后可引起1~3岁患儿术后早期出现不同程度的可逆的认知功能下降,在术后3个月内自行恢复.
목적 비교병박분혹의탁미지마취후대유인근、원기인지공능적영향.방법 100례1~3세의행택기복강경하산수보술환인,수궤분위병박분마취조( A조)、의탁미지마취조( B조)각50례;50례동년령단건강유인작대조조( C조). A、B조마취유도분별급여병박분1 ~3 mg·kg-1、의탁미지0.1 ~0.4 mg·kg-1 ,재차기출상균급여분태니( 1~2 ) ×10 -3 mg·kg-1、라고추안0.6~1.2 mg·kg-1 ,균우수술개시전급여분태니2 ×10 -3 mg·kg-1진행마취유지.A、B조균우술전1 d、술후3 d화3개월용패리영유인인지량표-Ⅲ( BSID-Ⅲ)안월령진행상응년령단적인지공능평고,C조동기진행,비교각조3개시기인지공능적개변. 결과 여술전 1 d 비교,A、B 조술후 3 d 평분균하강(P<0.05),술후인지공능장애환인분별위10례(20.0%)、9례(18.0%),술후3개월인지공능평분급술후인지공능장애발생솔차이무통계학의의( P>0.05 );A、B조비교,술후3 d、술후3개월인지평분급술후인지공능장애발생솔차이무통계학의의( P>0.05).결론 병박분혹의탁미지마취후가인기1~3세환인술후조기출현불동정도적가역적인지공능하강,재술후3개월내자행회복.
Objective To compare the effects of etomidate and propofol anesthesia on short -term and long -term cognitive ability of infants. Methods A total of 100 infants aged from 1 to 3 years old who were undergoing hernia repair surgery were randomly divided into propofol group ( group A) , etomidate anesthesia group ( group B) , each group 50 infants; another 50 healthy infants at the same age as control group ( group C).Group A and B were respectively given the induction of an-esthesia propofol 1-3 mg·kg-1 and etomidate 0.1-0.4 mg·kg-1 , on the basis of fentanyl (1-2) ×10 -3 mg·kg -1 and rocuronium 0.6-1.2 mg·kg-1 to both groups and giving fentanyl 2 ×10 -3 mg·kg-1 to maintain anesthesia prior to surgery.The infants of group A, B and C attended cognitive ability assessment according to their ages at 1 d before surgery, 3 d and 3 months after surgery by adopting Berry infant perceptions-Ⅲ( BSID -Ⅲ) .The changes of cognitive ability were observed during the three periods.Results Compared with 1 d before surgery, the scores of group A and B were lower than those at 3 d after surgery ( P <0.05 ) , with 10 children ( 20.0%) of post operative cognitive dysfunction( POCD) in group A and 9 (18.0%) in group B.The scores of cognitive ability assessment at 3 months after surgery and incidence of POCD in group A and B had no significant difference (P>0.05).The comparison between group A and B showed that the cognitive scores at 3 d and 3 months after surgery and the inci-dence of POCD had no significant difference ( P >0.05 ) .Conclusion Propofol or etomidate anesthesia can cause reversible cognitive ability decline with varying degrees among infants aged 1-3 years at the early stage after surgery and the cognitive ability can be restored by itself within 3 months after surgery.