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Narcotrend指数指导下双通道靶控输注麻醉对老年患者术后早期认知功能的影响
作者:马丽  徐波  邵伟栋  张兴安 
单位:广州中医药大学附属广州军区总医院 麻醉科, 广东 广州 510010
关键词:Narcotrend指数 靶控输注 术后认知功能 老年患者 
分类号:R614.2
出版年·卷·期(页码):2018·37·第五期(755-759)
摘要:

目的:研究Narcotrend指数(NI)指导下双通道靶控输注麻醉对老年患者术后早期认知功能的影响,并与单通道对比。方法:选择择期全麻仰卧位非心脏手术患者100例,年龄65~80岁,体质指数(BMI)18~25 kg·m-2,ASA分级为Ⅰ~Ⅲ级,术后住院时间≥ 7 d。采用随机数字表法将患者随机分为两组:双通道组(S组)和单通道组(D组),每组50例。S组丙泊酚和瑞芬太尼均采用靶控输注(TCI),在NI指导下采用固定比例调节丙泊酚和瑞芬太尼靶浓度,维持目标麻醉深度;D组丙泊酚采用靶控输注,瑞芬太尼采用恒速输注模式。由麻醉医师按照身高和体重等指标,经验性地调节丙泊酚靶浓度和瑞芬太尼泵注速度,维持目标麻醉深度。分别于术前1 d、术后3 d和术后7 d进行简易智能量表评分(MMSE)和视觉模拟评分(VAS),分别评估患者认知功能和疼痛程度。结果:各组与术前相比,术后3 d和7 d MMSE评分显著下降(P<0.05);而与术后3 d相比,各组术后7 d MMSE评分显著升高(P<0.05);组间比较,S组术后3 d和7 d MMSE评分显著高于D组(P<0.05)。术后3 d和7 d,两组VAS评分差异均无统计学意义(P>0.05)。结论:NI指导下双通道靶控输注麻醉与单通道麻醉相比,对老年患者术后早期认知功能有一定保护作用。

Objective:To investigate whether the dual-channel target anesthesia under Narcotrend index(NI) guidance having an advantage in protecting early postoperative cognitive function of the olderly patients compared with the single-channel. Methods:100 patients under general anesthesia for elective noncardiac surgery with supine position,aged 65 to 80 years old,BMI 18-25 kg·m-2, ASA Ⅰ-Ⅲ,postoperative hospital stay ≥ 7 days, were enrolled. These patients were randomly divided into two groups:S group and D group, 50 cases in each group. In S group the anesthesiologist chose propofol and remifentanil treated with target-controlled infusion (TCI), under the guidance of NI using a special algorithm to adjust the propofol and remifentanil target concentration in plasma, to maintain the target anesthesia depth; however the anesthesiologist adjust the propofol target concentration and remifentanil injection rate which were chosed constant rate infusion according with the experience to keep the anesthesia depth in D group. MMSE score and VAS score were performed at 1 day before operation, 3 days and 7 days after operation. Results:MMSE score decreased at 3 days and 7 days after operation both in S group and D group (P<0.05). And the MMSE score increased at 7 days after operation compared with that of the 3 days post-operatively (P<0.05). Compared with the D group, MMSE score of the S group was higher at 3 and 7 days after operation (P<0.05). However, no difference was found between two groups on VAS scores at both 3 and 7 days post-operatively (P>0.05). Conclusion:NI-guided dual-channel target-controlled infusion anesthesia protects post-operative cognitive function on the geriatric patients compared with single-channel anesthesia.

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