不同Narcotrend分级指导下全身麻醉对老年腹部手术患者术后认知功能的影响

发布时间：2018-09-18 20:52

【摘要】：目的探讨不同麻醉趋势(Narcotrend)分级指导下的全身麻醉对老年腹部手术患者术后认知功能的影响。方法择期全麻下行腹部手术老年患者150例,随机均分为三组(A、B和C组)。以咪达唑仑0.05 mg/kg、丙泊酚1 mg/kg、瑞芬太尼2μg/kg及罗库溴铵0.6 mg/kg诱导气管插管,术中以瑞芬太尼0.15μg/(kg·min)、顺式阿曲库铵及丙泊酚维持麻醉。调节丙泊酚泵注速度使A、B、C三组麻醉深度维持至相应水平(D064~57、D156~47、D246~37)。记录手术期间的Narcotrend分级(NT)及指数(NI),采用BIS作为平行对照。同时记录患者苏醒睁眼时间、拔管时间及各个时间点的心率和血压变化。分别于术前1 d和术后第7天使用简易精神状态量表(MMSE)及蒙特利尔认知功能量表(MoCA)对患者进行认知功能评估。结果①A、B和C组患者术后认知功能障碍(POCD)发生率分别为20.8%、15.2%和13.3%,差异无统计学意义(P0.05)。②A、B和C组患者术前及术中各个时间点的心率和血压比较差异无统计学意义(P0.05)。③三组患者拔管时间有显著差异(P0.05),B比A、C组苏醒拔管快。结论不同Narcotrend分级指导下全身麻醉对老年患者腹部手术术后认知功能无显著影响,处于D1级麻醉深度时苏醒拔管早。
[Abstract]:Objective to investigate the effect of general anesthesia with different anesthetic trends under (Narcotrend) classification on postoperative cognitive function in elderly patients undergoing abdominal surgery. Methods 150 elderly patients undergoing abdominal surgery under general anesthesia were randomly divided into three groups: group A (group B) and group C (group C). Midazolam 0.05 mg/kg, propofol 1 mg/kg, remifentanil 2 渭 g/kg and rocuronium 0.6 mg/kg were used to induce tracheal intubation. Anesthesia was maintained with remifentanil 0.15 渭 g / (kg min), cis atracurium and propofol. Adjusting the injection speed of propofol pump to maintain the anesthesia depth to the corresponding level (D06457-D156N 47 D246C37). Narcotrend grading (NT) and index (NI), were recorded during operation using BIS as parallel control. At the same time, the changes of heart rate and blood pressure at each time point were recorded. (MMSE) and (MoCA) were used to evaluate the cognitive function of the patients 1 day before operation and 7 days after operation. Results 1the incidence of (POCD) in patients with cognitive dysfunction in group A, B and C was 20. 8% and 13. 3%, respectively. There was no significant difference in heart rate and blood pressure between group B and group C (P0.05). There was no significant difference in heart rate and blood pressure between group C and group B (P0.05). 3There was significant difference in extubation time among the three groups (P0.05). Conclusion General anesthesia under the guidance of different Narcotrend grades has no significant effect on cognitive function after abdominal surgery in elderly patients.
【作者单位】：南方医科大学南京临床学院(南京军区南京总医院)麻醉科;
【基金】：南京军区面上课题(2011034)
【分类号】：R614.2

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