三种全身麻醉方法对腹腔镜胆囊切除术后患者早期认知功能的影响分析

摘要

目的：探讨三种全身麻醉方法对腹腔镜胆囊切除术患者术后早期认知功能影响。方法选取行腹腔镜胆囊切除术的113例患者，按术中不同麻醉方法分为 A 组（40例）、B 组（37例）和 C 组（36例）。 A 组给予全程吸入药物麻醉、B 组给予全程静脉麻醉、C 组给予静脉麻醉＋吸入麻醉，均用简易智能量表（MMSE）评定患者麻醉前和术后1、3、5 d 的认知功能，比较各项围术期指标，并分析可能影响术后认知功能的危险因素。结果在术后1、3 d ，3组患者 MMSE 评分均较麻醉前有不同程度的下降（P＜0．05），但3组间 MMSE 评分差异无统计学意义（P＞0．05）。3组患者术后5 d 的 MMSE 评分均较麻醉前差异无统计学意义（P＞0．05）。 A 、B 、C 组分别有6、6、5例患者出现认知功能障碍，发生率分别为15．0％、16．2％、13．9％，差异无统计学意义（P ＞0．05）。受教育年限、手术时间、年龄均为术后认知功能障碍的影响因素。年龄是术后认知功能障碍发生的独立危险因素（OR ＝2．351，P ＜0．05）。结论腹腔镜胆囊切除术患者应用不同的全身麻醉方法对其术后早期认知功能有一定影响，但不同麻醉方法影响无明显差异。%Objective To investigate the effects of three kinds of anesthesia method on early postoperative cognitive function in the patients with laparoscopic cholecystectomy .Methods 113 cases of laparoscopic cholecystec‐tomy were chosen and divided into the group A(40 cases) ,B(37 cases) and C(36 cases) according to different anes‐thesia methods during operation .The group A was given the entire inhalation anesthesia ,the group B received total intravenous anesthesia and the group C was given intravenous anesthesia plus inhalation anesthesia .The cognitive function was evaluated before anesthesia and on postoperative 1 ,3 ,5 d by the mini‐mental state examination (MMSE) ,the perioperative indexes were compared ,and the possible risk factors FFAecting the postoperative cogni‐tive function were analyzed .Results The MMSE scores on postoperative 1 ,3 d in the three groups were decreased to different degrees compared with those before anesthesia(P< 0 .05) ,but no statistically significant differences in the MMSE score existed among the three groups(P> 0 .05) ,the MMSE scores on postoperative 5 d in the three groups had no statistical difference compared with those before anesthesia(P> 0 .05) .The cognitive dysfunction occurrence :6 cases in the group A ,6 cases in the group B and 5 cases in the group C ,the occurrence rates were 15 .0% ,16 .2%and 13 .9% respectively ,the differences were not statistically significant (P > 0 .05) .The education years ,operative time and age were the influencing factors of postoperative early cognitive function .Age was the independent risk fac‐tor of postoperative cognitive function disorder (OR = 2 .351 ,P < 0 .05) .Conclusion Different anesthesia methods have a certain effect on early cognitive function in the patients with laparoscopic cholecystectomy ,but the effects of different anesthetic methods have no obvious difference .