摘要
目的 探讨围术期脑氧饱和度(rSO_2)与异氟醚及七氟醚复合静脉麻醉下患者术后认知功能变化的关系,确定患者术后发生认知功能变化的rSO_2界值。方法 60例患者,ASAⅠ～Ⅱ级,年龄>60岁,行择期腹部及下肢手术。麻醉前均不用术前药,静注异丙酚、芬太尼、维库溴铵快速诱导气管插管,机械通气,维持呼末CO_2分压在正常范围。根据文化程度分为3组(n=20),麻醉维持采用吸入麻醉,以吸入麻醉药平均呼末浓度为1MAC,随机分为2个亚组:异氟醚亚组和七氟醚亚组(n=10),术中定时追加芬太尼和维库溴铵。记录入室后、吸氧后、麻醉诱导后、手术开始后、术中、术毕时的rSO_2界值,术中监测在吸入麻醉药平衡15min后,平均呼气末浓度为1.0MAC时开始记录rSO_2。应用Mini-Mental State Examination(MMSE)测试方法调查患者入室后和术后1、4、8、12、24h的认知功能变化,常规监测血液动力学指标。结果 rSO_2在各亚组术中、术毕与入室后相比显著性下降(P<0.05)。各组及各亚组诱导后、术中、术毕、苏醒时血液动力学参数的变化差异无显著性(P>0.05)。术后1h的MMSE评分与入室后相比显著性下降(P<0.05)。术后1～4h患者均发生短暂的认知功能下降,4h后85％患者认知功能恢复。发生短暂认知功能下降的rSO_2界值在异氟醚亚组中文盲患者为45、小学组患?
Objective To investigate the relationship of intraoperative cerebral oxygen saturation(rSO_2 )
monitored with near-infrared cerebral oximeter (INNOS 5100) and postoperative cognitive dysfunction in patients
operated upon under isoflurane or sevoflurane anesthesia and to determine the critical rSO_2 value below which
postoperative cognitive dysfunction may occur.Methods Sixty ASA Ⅰ- Ⅱ patients of both sexes aged 62-80 yr,
weighing58-77 kg schedules for elective abdominal surgery or surgery on the low limb were divided into three
groups according to their levels of education: group Ⅰthe illierate and uneducated (n = 20); group Ⅱ primary
school education (<6yr education) (n = 20) and group Ⅲ>6yr education (n = 20). Each group was further
divided into isoflurane and sevoflurane subgroups (n = 10 in each subgroup). The patients were unpremedicated.
Anesthesia was induced with intravenous atropine 0. 3mg, propofol 1 .0-1. 5 mg·kg^(-1), fentanyl 2-3μg·kg^(-1) and
vecuronium o. 1-0.2 mg·kg^(-1) and maintained with isoflurane or sevoflurane inhalation (0.9-1. 1 MAC )
supplemented with intermittent i.v. boluses of fentanyl and recorded before anesthesia (baseline), after O_2
inhalation(T_1), after induction of anesthesia(T_2), after skin incision (T_3), during operation (T_4)and at the end of
surgery (T_5). Mini-Mental State Examination (MMSE) was performed before anesthesia and 1,4, 8, 12 and 24 h
after surgery. BP, HR, ECG, SpO_2, P_(ET) CO_2 and end-tidal concentration of inhalational anesthetics were
continuously monitored during anesthesia. Results In all three groups rSO_2 was significantly lower during operation
(T_4) and at the end of surgery (T_5 ) than baseline (T_0 ) (P<0.05). In all patients the MMSE scores at 1 h after
operation were significantly lower than the baseline value before anesthesia (P<0.05 ). All patients had
significantly decline in MMES scores during 1-4 h after surgery and in 85 % patients cognitive function recovered at
4 h after surgery. The critical rSO_2 values below which postoperative cognitive dysfunction may occur were: for
isoflurane anesthesia 45 (group Ⅰ),47 (group Ⅱ) and 49 (group Ⅲ);for sevoflurane 47 (group Ⅰ),48 (group
Ⅱ) and 50 (group Ⅲ ) .Conclusion The perioperative rSO_2 should be maintained above 50 to reduce the
incidence of postoperative dysfunction.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2004年第5期348-351,共4页
Chinese Journal of Anesthesiology
