无痛上消化道内镜检查对术后早期认知功能的影响

摘要

背景：近年来，无痛内镜检查后24 h内不能驾车的规定受到越来越多的质疑。目的：探讨无痛内镜检查对术后早期认知功能的影响。方法：随机选取至少接受9年义务教育、进行无痛上消化道内镜检查（ EGD）的患者100例，100例进行普通EGD检查的患者作为对照组。丙泊酚麻醉或内镜操作前以数字连接试验-A（ NCT-A）、数字划消试验和数字符号试验（ DST）进行认知功能测试，达到离院标准时重复上述测试，如结果劣于检查前，静息30 min后进行第三次测试，直至结果恢复至或优于检查前水平。结果：200例患者均完成前两次测试，124例完成第三次测试。达到离院标准时，无痛EGD组数字划消试验结果显著劣于检查前（ P=0.000）；进一步按年龄段分组，青年组数字划消试验结果显著劣于检查前（P=0.000），老年组NCT-A结果显著劣于检查前（P=0.025）；普通EGD对照组3项测试结果均不劣于检查前。完成第三次测试者各项测试结果均恢复至或优于检查前水平。结论：丙泊酚无痛内镜检查可影响患者的术后早期认知功能，但此种影响可通过适当延长离院时间得以恢复。患者的最适离院时间以及多久后方可驾车有待进一步研究确定。%Background:It is commonly recommended that patients should refrain from driving for 24 hours after sedation for endoscopy,however,this recommendation has been queried recently. Aims:To investigate the effect of sedation on early postoperative cognitive function in patients undergoing endoscopy. Methods:One hundred adult patients undergoing sedative esophagogastroduodenoscopy ( EGD ) were randomly recruited, and another 100 adult patients undergoing conventional EGD were served as controls. All patients had an education level more than 9 years. Cognitive function was assessed by number connection test-A( NCT-A),number cancellation test and digit symbol test( DST)before propofol sedation or the beginning of endoscopic procedure and was reassessed when the discharge criteria were met. If the results obtained were inferior to those before EGD,a third assessment was taken 30 minutes later until the results recovered or being superior to the baseline levels. Results:All patients completed the first and second assessment,and 124 patients had taken the third assessment. When the discharge criteria were met,result of number cancellation test was inferior to that before EGD in sedation group( P =0. 000 ). Furthermore,the results were analyzed by grouping with age,number cancellation test in young patients and NCT-A in elderly patients were inferior to that before EGD,respectively(P=0. 000 and P =0. 025 ). In control group,none of the results were inferior to those before EGD. The results of the third assessment recovered or being superior to the baseline levels. Conclusions:Early postoperative cognitive dysfunction at discharge is common in patients undergoing endoscopy using propofol sedation,but the impairment will recover by a prolonged staying calm before discharge. The optimal time for discharge and resuming driving remains to be further studied.