不同麻醉方法对老年颅内肿瘤患者术后不同时段认知功能的影响研究

摘要

目的 观察靶控静脉麻醉与静吸复合麻醉对老年颅内肿瘤患者术后不同时段认知功能的影响.方法 临床纳入老年颅内肿瘤手术患者70例,根据术中麻醉方法的不同分为研究组与对照组,研究组实施丙泊酚复合瑞芬太尼靶控静脉麻醉,对照组实施静脉复合吸入异氟醚.观察两组患者术后恢复情况(呼吸恢复时间、睁眼时间、拔管时间、定向力恢复时间等)以及手术前后意识状态(OAAS)评分、认知功能(MMSE)评分等.结果 两组患者呼吸恢复时间、睁眼时间、拔管时间差异均无统计学意义(P＞0.05);研究组定向力恢复时间为(20.4±5.8)min,对照组为(23.2±4.3)min,差异有统计学意义(P＜0.05);研究组拔管即刻、离开手术室、拔管后1 h OAAS评分分别为(3.3±0.5)、(4.2±0.4)、(4.6±0.6),对照组分别为(2.3±0.2)、(3.3±0.4)、(3.9±0.3),差异均有统计学意义(P＜0.05);两组患者术前MMSE评分差异无显著性(P＞0.05);研究组术后24h、48 h MMSE评分分别为(25.0±0.4)、(27.9±1.1),对照组分别为(23.2±0.9)、(25.8±1.3),差异有统计学意义(P＜0.05).结论 对老年颅内肿瘤手术患者实施丙泊酚复合瑞芬太尼靶控静脉麻醉,诱导平稳且苏醒完全,对患者术后认知功能的影响相对较小.%Objective The objective of this study was to observed the effect of target control intravenous (TCI) anesthesia and intravenous inhalational anesthesia in the postoperative cognitive function in elderly patients with intracranial tumor at different time points.Methods Seventy patients were divided into the experimental and control groups according to the different methods of intraoperative anesthesia.The experimental group was selected to treat with propofol combined with remifentanil TCI anesthesia,and the control group was treated with intravenous anesthetics combined with inhalation isoflurance.Recovery time of respiration,time of opening eyes,extuation time,orientation recovery time,OAAS score before and after operation,and cognitive function (MMSE)were observed in two groups.Results They were no differences in the recovery time of respiration,time of opening eyes and extubation time in two groups (P ＞ 0.05).The orientation recovery time in the experimental group was 20.4 ± 5.8 min and 23.2 ± 4.3 min in the control group.They had significantly different between experimental and control groups (P ＜ 0.05).The time of extubation,leaving the operating room and after 1 h of extubation,OAAS point for the experimental group was 3.3 ± 0.5,4.2 ± 0.4,4.6 ± 0.6 min,respectively,and 2.3 ± 0.2,3.3± 0.4,3.9 ± 0.3 in the control group,respectively.They were significantly different between the experimental and control groups(P ＜ 0.05).Prior to treatment,there was no significant difference in MMSE score between the two groups(P ＞0.05).MMSE score was 25.0 ±0.4 and 27.9 ± 1.1 in the experimental group after treatment for 24 h and 48 h,respectively.MMSE score in the control group was 23.2 ±0.9 and 25.8 ± 1.3 after treatment for 24 and 48 h,respectively.There had a significant different from two groups (P ＜ 0.05).Conclusion For elderly patients with intracranial tumor surgery,TCI anesthesia with propofol and remifentanil is stable and awake,and the effect on postoperative cognitive function is relatively small.