帕金森病患者行下腹或下肢手术全麻苏醒质量及认知功能的变化

发布时间：2018-06-11 12:07

本文选题：帕金森病 + 苏醒时间　；参考：《临床麻醉学杂志》2015年05期

【摘要】：目的观察帕金森病患者行下腹或下肢手术全麻苏醒苏醒质量及认知功能的变化。方法选择择期在全身麻醉下行下腹或下肢手术的帕金森病患者26例(PD组)和在全身麻醉下行下腹或下肢手术的无帕金森病病史患者26例(NP组),于术前1d采用简易精神状态量表(MMSE)对认知功能评分。两组均使用咪达唑仑、芬太尼、顺阿曲库铵、丙泊酚行麻醉诱导,术中丙泊酚以5mg·kg-1·h-1和瑞芬太尼6μg·kg-1·h-1为起始输注速度,并根据BIS和MAP调节两种麻醉药物输注速度维持适宜麻醉深度,记录低血压发生次数和升压药物用量。术毕停止丙泊酚和瑞芬太尼的输注,观察并记录首次睁眼时间、拔管时间、达OAA/S评分5分时所需时间及术后24h的MMSE评分。结果 NP组术中瑞芬太尼和丙泊酚用量明显多于PD组(P0.05),NP组血压下降次数和去氧肾上腺素用量明显少于PD组(P0.05);NP组的首次睁眼时间、拔管时间、达OAA/S评分5分时所需时间明显短于PD组(P0.05);NP组术后24h的MMSE评分明显高于PD组(P0.05)。多元线性回归分析显示:帕金森病(β=0.513,t=3.350,P0.05)是影响达到OAA/S 5分所需时间的显著预测变量(R2=0.256,回归模型F=3.163,P0.05)。其余因素均为不显著的预测变量。帕金森病(β=0.468,t=3.203,P0.05)也是影响术后24h MMSE评分的显著预测变量(R2=0.325,回归模型F=4.430,P0.05)。其余因素均为不显著的预测变量。结论帕金森病患者较非帕金森病患者的全身麻醉苏醒时间延长,术后24h认知功能显著低于非帕金森病患者。
[Abstract]:Objective to observe the changes of recovery quality and cognitive function in patients with Parkinson's disease undergoing lower abdominal or lower limb surgery under general anesthesia. Methods A total of 26 patients with Parkinson's disease undergoing lower abdominal or lower limb surgery under general anesthesia and 26 patients with no history of Parkinson's disease undergoing lower abdominal or lower extremity surgery under general anesthesia were enrolled in this study. Mental state scale (MMSE) was used to evaluate cognitive function. Midazolam, fentanyl, cisatracurium and propofol were used to induce anesthesia. The initial infusion rate of propofol was 5mg kg-1 h-1 and remifentanil 6 渭 g kg-1 h-1, and the appropriate depth of anesthesia was maintained according to BIS and map. The incidence of hypotension and the dosage of antihypertensive drugs were recorded. The infusion of propofol and remifentanil was stopped at the end of the operation. The first time of eye opening, the time of extubation, the time required to reach the OAA / S score of 5 and the MMSE score 24 hours after operation were observed and recorded. Results the dosage of remifentanil and propofol in NP group was significantly higher than that in PD group (P 0.05). The time required to reach OAA / S score at 5 was significantly shorter than that in PD group (P 0.05 / NP group) 24 h after operation, and was significantly higher than that in PD group (P 0.05). Multivariate linear regression analysis showed that Parkinson's disease (尾 = 0.513) was a significant predictor of the time required to reach OAA / S score (P 0.05), and the regression model was F _ (3.163) (P _ (0.05), which was a significant predictor of the time required to reach OAA / S _ (5). The other factors were not significant predictive variables. Parkinson's disease (P = 0.468) was also a significant predictor of MMSE score at 24 hours postoperatively (P < 0.05), and the regression model was F _ (4.430) (P _ (0.05). The other factors were not significant predictive variables. Conclusion the recovery time of general anesthesia in patients with Parkinson's disease is longer than that in patients with non Parkinson's disease, and the cognitive function at 24 hours after operation is significantly lower than that in patients with non Parkinson's disease.
【作者单位】：河北医科大学附属哈励逊国际和平医院麻醉科;河北医科大学附属哈励逊国际和平医院神经内科;
【分类号】：R614

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