不同拔管方案对行全身麻醉老年患者术后认知功能的影响

摘要

Objective:To observe the influence of different extubation on the postoperative cognitive function in elderly patients with general anaesthesia. Methods:Eighty elderly patients scheduled by operation under general anaesthesia were randomly divided into the remifentanil-dexmedetomidine group(group R) and control group(40 cases each group). Two groups were induced using fentanyl-propofol-rocurunium bromide scheme, and maintained anaesthesia using propofol-remifentanil-cisatracuriumbesylate scheme. After operation,the group R patients were injected with 0. 03 μg · kg-1 · min-1 of remifentainil and 0. 01 μg · kg-1 · min-1 of dexmedetomidine until postextubation 5 minutes. The control group were injected with the same dose of 0. 9% sodium chloride until postextubation 5 minutes. The congnitive functions of all patients at preoperation,and postoperative 1 and 3 days were assessed using the Mini-Mental State Examination, and the levels of blood glucose and blood lactic acid in two groups were detected at preoperation, intubation and extubation. Results:The difference of the congnitive function between two groups before operation was not statistically significant(P>0. 05),and the scores of congnitive function in group R at postoperative 1 and 3 days were significantly higher than that in control group(P0. 05),and the scores of congnitive function at postoperative 1 and 3 days were significantly lower than that before operation in control group(P 0. 05). The differences of the levels of blood glucose and blood lactic acid between preoperation, intubation and extubation in group R were not statistically significant(P>0. 05). The level of blood glucose in control group at extubation was significantly higher than that in control group at preoperation and intubation,and group R(P 0. 05). Conclusions:The application of remifentainil and dexmedetomidine during extubation can decrease the influence of the postoperative cognitive function in elderly patients.%目的：：观察不同拔管方案对行全身麻醉的老年患者术后认知功能的影响。方法：选择择期手术拟行气管插管全身麻醉的老年患者80例,随机分为瑞芬太尼-右美托咪定组( R组)和对照组( C组)各40例。均采用芬太尼-丙泊酚-罗库溴铵方案诱导,丙泊酚-瑞芬太尼-顺式阿曲库胺方案维持麻醉。手术结束后,R组入复苏室后予瑞芬太尼0.03μg·kg-1· min-1和右美托咪定0.01μg·kg-1·min-1持续泵注至拔管后5 min；C组入复苏室后予相同剂量0.9%氯化钠注射液持续泵注至拔管后5 min。所有患者于术前、术后第1天、第3天采用简易精神状态量表评价认知功能；并于术前、气管插管即刻、拔管即刻测血糖和血乳酸值。结果：2组患者术前认知功能评分差异无统计学意义(P>0.05),术后第1天和第3天R组患者认知功能评分均明显高于C组(P0.05)；而C组患者术后第1天和第3天认知功能评分均显著低于术前(P0.05)；R组术前、气管插管和拔管即刻血糖和血乳酸差异均无统计学意义(P>0.05),C组气管拔管即刻血糖均明显高于术前和气管插管即刻及R组(P0.05)。结论：采用瑞芬太尼-右美托咪定在拔管过程中持续输注,有助于降低对老年患者认知功能的影响。