摘要
目的应用近红外光谱(INVOS5100)脑氧饱和度(rSO2)监测研究静吸复合麻醉下患者rSO2变化与术后认知功能之间的关系,界定静吸复合麻醉下患者认知功能变化的rSO2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CO2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:异氟醚亚组和七氧醚亚组(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、术中、术毕时的rSO2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rSO2。应用MiniMentalStateExamination(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,常规监测血流动力学指标。结果rSO2在6个亚组术中、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、苏醒时血流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rSO2界值在异氟醚亚组中文盲患者为45、小学组患者为47、中学及以上组患者为49;在七氧醚亚组中文盲患者为47、小学组患者为48、中学及以上组患者为50。结论在静吸复合麻醉下,围术期患者的脑氧饱和度数值应高于50以确保术后患者不发生一过性的认知功能不全。
To investigate the relationship between intraoperative cerebral oxygen saturation （rSO2） and postoperative cognitive dysfunction with near-infrared cerebral oximeter （INVOS 5100） in patients operated under inhalational combined intravenous anesthesia, and to determine the critical rSO2 value below which postoperative cognitive dysfunction may occur. Methods Sixty ASAⅠ-Ⅱ patients of both sexes were selected, aged 62-80yr, weighed 58 -77kg, scheduled for elective abdominal surgery or surgery on the low limb. All the patients were divided into three groups according to their educational background： in group I were the illiterate and uneducated patients （n=20） ; group Ⅱ the primarily eduCated patients （〈6yr education） （n=20）, and group Ⅱ the well educated patients （〈6yr education） （n= 20）. Each group was further divided into isoflurane and sevotlurane subgroups （n= 10 in each subgroup）. All patients received no pre-medication. Anesthesia was induced with intravenous atropine 0. 3rng, propofol 1.0-1.5mg kg^- 1, fentanyl 2-3μg · kg^-1 and vecuronium 0. 1-0. 2mg·kg^-1, and maintained with isoflurane or sevoflurane inhalation（0. 9- 1. 1 MAC） supplemented with intermittent i.v. boluses of fentanyl, and recorded after entering room （baseline） （To）, after O2 inhalation （T1）, after induction of anesthesia （T2）, after skin incision （T3）, during operation （T4）, the end of surgery （T5）, and awaking （T6）. Mini-Mental State Examination （MMSE） was performed before anesthesia and 1, 4, 8, 12 and 24h after surgery. BP, HR, ECG, SpO2, PETCO2 and end-tidal concentration of inhalational anesthetics were continuously monitored during anesthesia. Results In all three groups rSO2 was significantly lower during operation （T4） and at the end of surgery （T5） than baseline （To） （P〈0. 05）. In all patients the MMSE scores at lh after operation were significantly lower than the baseline value （P〈0. 05）. The MMES scores in all patients significantly declined within 1-4h after surgery, and the cognitive function recovered at 4h after surgery in 85% patients. The critical values of rSO2 below which postoperative cognition dysfunction may occur were： 45 （group Ⅰ）, 47 （group Ⅱ） and 49 （group Ⅲ） for isoflurane anesthesia subgroups; 47 （group D, 48 （group Ⅱ） and 50 （group Ⅲ） for sevoflurane subgroups. Conclusion The perioperative rSO2 should be maintained up to above 50% to reduce the incidence of postoperative cognitive dysfunction under inhalational combined intravenous anesthesia.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2005年第9期792-795,共4页
Medical Journal of Chinese People's Liberation Army
基金
SupportedbyNationalNaturalScienceFoundation(No.30340075)
关键词
老年人
认知障碍
氧消耗
麻醉
全身
aged
cognition disorders
oxygen consumption
anesthesia, general
