氟马西尼对七氟烷术后认知功能的影响

发布时间：2018-01-18 15:42

本文关键词：氟马西尼对七氟烷术后认知功能的影响　出处：《南昌大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的:观察不同时间点MMSE评分以及术前术后血清皮质醇浓度变化和苏醒质量对比，初步探讨氟马西尼对七氟烷术后认知功能的影响及机制。方法:选择拟行腹腔镜下子宫切除术患者60例为研究对象，年龄40-60岁，ASA I～II级,随机分为实验组（F1组，，n=20）、静脉组（F2组，n=20）、对照组（C组，n=20）三组，术前1天访视病人，交待术前注意事项，取得病人和家属的同意。无术前用药，入手术室后，常规开放上肢静脉，接心电监护，依病人情况以芬太尼3-5ug／kg、丙泊酚1.5-2.0mg／kg，维库溴铵0.08-0.12mg／kg诱导， F1、C组术中吸入2-4%七氟烷维持+瑞芬太尼泵注，F1组术后静注氟马西尼0.5mg，C组术后使用等量生理盐水，F2组术中用丙泊酚+瑞芬太尼维持，术后静注氟马西尼0.5mg。术中通过调节七氟烷吸入浓度和丙泊酚、瑞芬太尼泵注速度维持麻醉熵值在40-50。手术结束前30分钟给予昂丹司琼4mg静注。开始缝皮时停止七氟烷吸入和丙泊酚，接静脉镇痛泵，手术结束时停止瑞芬太尼泵注。当呼气末七氟烷浓度下降至0.45％～0.50％，或病人出现自主呼吸时给予实验药物。三组患者均于术前（T0）、术后1h（T1）、12h（T2）、24h（T3）、48h（T4）分别由同一试验者采用简易精神状态量表检查（MMSE）对认知功能进行评价，并记录三组麻醉停止后患者呼之睁眼、指令运动、定向力恢复时间，并在拔管即刻（S1）、拔管后10min（S2）、拔管后15min(S3)进行Steward苏醒评分。三组患者于麻醉前、拔管后采中心静脉血3ml，使用ELISA方法进行测定血浆皮质醇浓度。统计学处理采用SPSS18.0软件包完成。计量资料以均数（x）±标准差(s)表示，组内比较采用配对t检验，组间比较采用方差分析。以P＜0.05为差异有统计学意义，以P＜0.01为差异有显著性。结果: （1）三组病人在年龄、体重、受教育年限、麻醉时间等方面无明显差异（P＞0.05）。（2）术后苏醒质量的变化：三组患者睁眼时间无统计学意义；F1组和F2组定向力恢复时间较C组快，差异有统计学意义(P＜0.05)；F2组指令运动恢复时间较C组短，差异有统计学意义(P＜0.05)。（3）Steward评分：三组内Steward评分依次升高，C组在时间点S3的评分较S1明显升高，差异有统计学意义(P＜0.05)；F1组和F2组在时间点S1、S2的Steward评分较C组高，差异有统计学意义(P＜0.05)；与F2组比较时，F1组各时间点的Steward评分均低，但差异无统计学意义（P＞0.05）。（4）术后认知功能的变化：三组患者术后MMSE评分显示拔管后认知功能较术前均有不同程度的降低，呈逐渐升高趋势，三组依次在时间点T3、T2、T4恢复到术前水平；F1组和F2组在时间点T1、T2、T3认知功能评分均较C组高，P＜0.05，差异有统计学意义；在T2时间点F1、F2两组组间比较P＜0.05，差异具有统计学意义。（5）血浆皮质醇的变化：三组术后均比术前增高，F1和C组的变化有统计学意义(P＜0.05)；组间比较，F1组和F2组在术后血浆皮质醇浓度较C组低，差异有统计学意义(P＜0.05)。结论：在本实验条件下，七氟烷会对患者的短期认知功能产生可逆性损害，其恢复到正常认知功能水平的时间较丙泊酚长，静注0.5mg氟马西尼可在一定程度上改善七氟烷术后的苏醒质量，加快认知功能的恢复。血浆皮质醇的变化提示，氟马西尼这种改善认知功能的作用可能与减轻应激反应有关。
[Abstract]:Objective: To observe the MMSE score and the changes of serum cortisol concentration and recovery quality at different time points, and to preliminarily explore the effect and mechanism of Flumet on postoperative cognitive function after seven flurane.
Methods: undergoing laparoscopic hysterectomy in 60 patients as the research object, age 40-60 years old, ASA I ~ II, were randomly divided into experimental group (group F1, n=20), vein group (group F2, n=20), control group (group C, n=20) three groups, 1 day preoperative visit as a patient, explain precautions before operation, the patient and family's consent. No premedication into the operation room after conventional open vein of upper limb, with ECG monitoring, according to the patient's condition with fentanyl 3-5ug / kg, 1.5-2.0mg / kg 0.08-0.12mg propofol, vecuronium induced / kg, F1, C groups were inhaled 2-4% seven halothane maintain + remifentanil infusion, F1 group after intravenous injection of flumazenil using 0.5mg, normal saline C group after operation, maintenance operation in F2 group with propofol + remifentanil, postoperative intravenous injection of flumazenil in the 0.5mg. through the regulation of seven isoflurane and propofol remifentanil concentration, infusion rate to maintain anesthesia in entropy 40-50. operation Beam 30 minutes before giving ondansetron 4mg intravenous injection. Start skin closure of seven isoflurane inhalation and propofol, received intravenous analgesia pump, stop using remifentanil at the end of the operation. When the seven end tidal isoflurane concentration decreased to 0.45% ~ 0.50%, given the experimental drug or patient respiration. Three groups of patients in operation before (T0), 1h after operation (T1), 12h (T2), 24h (T3), 48h (T4) respectively by the same test using the mini mental state examination (MMSE) to evaluate the cognitive function, and record the three groups of patients after anesthesia stop called the open, instruction movement the recovery time of orientation, and immediately pull on the tube (S1), 10min after extubation (S2), 15min after extubation (S3) Steward awakening score. Three groups of patients before anesthesia, extubation after recovery of central venous blood 3ml, using the ELISA method for determination of plasma cortisol concentration. Statistical processing by SPSS18.0 the measurement data to software. Mean (x) + standard deviation (s). In group comparison, paired t test was used. Variance analysis was used between groups. The difference between P and < 0.05 was statistically significant, and the difference between P and < 0.01 was significant.
Result:
(1) there was no significant difference between the three groups in age, weight, years of education, and time of anesthesia (P > 0.05).
(2) the change of recovery quality after operation: there was no significant difference in eye opening time between the three groups. The recovery time of directional power in group F1 and group F2 was faster than that in group C (P < 0.05); the time of instruction recovery in group F2 was shorter than that in group C (P < 0.05).
(3) Steward score: three groups in Steward score were significantly increased, C group at the time point of S3 was significantly higher than that of the S1, the difference was statistically significant (P < 0.05); F1 group and F2 group at the time point of S1 S2, the Steward score was higher than that in group C, the difference was statistically significant (P < 0.05); compared with F2 group, F1 group at different time points of Steward score were low, but the difference was not statistically significant (P > 0.05).
(4) the change of cognitive function after surgery: three groups of patients with postoperative MMSE scores after extubation of cognitive function than before were reduced in different degree, the trend was gradually increased, the three groups were at the time point of T3, T2, T4 returned to the preoperative level; F1 group and F2 group at the time point of T1 T2, T3 cognitive function scores were higher than C group, P < 0.05, the difference was statistically significant; in T2 time point F1, F2 between the two groups P < 0.05, the difference was statistically significant.
(5) the change of plasma cortisol: the three groups were all higher than those before operation, and the changes in group F1 and C were statistically significant (P < 0.05). The plasma cortisol concentration in group F1 and F2 after operation was lower than that in C group, the difference was statistically significant (P < 0.05).
Conclusion:
In this experiment, seven halothane will produce reversible damage to short-term cognitive function of patients, restore to normal levels of cognitive function than propofol long time, intravenous injection of 0.5mg fluorine Marie Nicole is improved to a certain extent after seven halothane recovery quality, accelerate the recovery of cognitive function. The results suggest that changes of plasma cortisol this, flumazenil to improve cognitive function may be related to relieve stress.

【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614

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