深度、中度和浅度麻醉对老年全身麻醉患者术后认知功能的影响对比

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摘要目的探讨深度、中度和浅度麻醉对老年全身麻醉患者术后认知功能的影响。方法选取2014年2月～2017年2月于我院进行全身麻醉下择期胃肠道肿瘤手术的69例老年患者，随机分为L组、M组及D组，各23例。L组行浅度麻醉，M组行中度麻醉，D组行深度麻醉。比较三组的麻醉时间、补液量、出血量、定向力恢复时间以及不同时期的心率（HR）、平均动脉压（MAP）、POCD发生率、和手术前后的MMSE评分。结果三组的麻醉时间、补液量、出血量比较，差异无统计学意义（P＞0.05）。D组的定向力恢复时间显著长于L组和M组，差异有统计学意义（P＜0.05）。D组插管前、术中1 h以及术中2 h的HR、MAP均显著低于L组和M组，差异有统计学意义（P＜0.05）。三组定向力恢复后30 min的HR、MAP比较，差异无统计学意义（P＞0.05）。三组插管前、术中1 h及术中2 h的HR、MAP均显著低于诱导前，差异有统计学意义（P＜0.05）。D组术后24、48 h的POCD发生率均显著低于L组和M组，差异有统计学意义（P＜0.05）。M组术后24、48 h的POCD发生率显著低于L组，差异有统计学意义（P＜0.05）。三组术后1周的MMSE评分均显著低于术前，差异有统计学意义（P＜0.05）。L组和M组术后3个月的MMSE评分低于术前，差异有统计学意义（P＜0.05）。D组术后3个月的MMSE评分与术前比较，差异无统计学意义（P＞0.05）。结论对老年全身麻醉患者而言，深度麻醉能够有效降低老年患者的POCD发生率，相对于其他麻醉深度而言，其对患者的认知功能会影响较小。

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	王靖
	石磊
	田先树

关键词 ：麻醉深度, 认知功能, 全身麻醉

Abstract：ObjectiveTo explore the influence of depth,moderate and superficial anesthesia on postoperative cognitive function in elderly patients undergoing general anesthesia.Methods69 elderly patients scheduled to undergo elective gastrointestinal tumor surgery under general anesthesia in our hospital from February 2014 to February 2017 were selected and randomly divided into group L,group M and group D,23 cases in each group.Group L was given superficial anesthesia,group M was given moderate anesthesia,and group D was given deep anesthesia.The time of anesthesia,the amount of fluid infusion,the amount of bleeding,the recovery time of the directional force,the heart rate (HR),the mean arterial pressure (MAP),the incidence rate of POCD and the MMSE score before and after the operation were compared between the three groups.ResultsThere was no significant difference in the time of anesthesia,the amount of fluid infusion and the amount of bleeding between the three groups (P＞0.05).The recovery time of directional force in group D was significantly longer than that in group L and group M,with significant difference(P＜0.05).The level of HR,MAP before intubation,1 hour and 2 hours during the operation in group D were significantly lower than those in group L and group M,with significant difference (P＜0.05).There was no significant difference in the level of HR and MAP after the restoration of the directional force at 30 min between the three groups(P＞0.05).The level of HR and MAP before intubation, 1 hour and 2 hours during the operation in the three groups were significantly lower than those before induction,with significant difference(P＜0.05).The incidence rate of POCD at 24 hours and 48 hours after operation in group D was significantly lower than that in group L and group M,with significant difference(P＜0.05).The incidence rate of POCD at 24 hours and 48 hours after operation in group M was significantly lower than that in group L,with significant difference (P＜0.05).The MMSE scores at 1 week after operation in the three groups was significantly lower than that before the operation,with significant difference(P＜0.05).The MMSE score at 3 months after operation in group L and group M was lowerthan that before operation,with significant difference(P＜0.05).There was no significant difference in MMSE score in group D between before operation and at 3 months after operation(P＞0.05).ConclusionFor elderly patients with general anesthesia,deep anesthesia can effectively reduce the incidence rate of POCD in elderly patients,compared with other depth of anesthesia,the patient′s cognitive function will be less affected.

Key words： Depth of anesthesia Cognitive function General anesthesia

引用本文:

王靖;石磊;田先树. 深度、中度和浅度麻醉对老年全身麻醉患者术后认知功能的影响对比[J]. 中国当代医药, 2017, 24(17): 120-123.
WANG Jing;SHI Lei;TIAN Xian-shu. Comparison of the influence of depth,moderate and superficial anesthesia on postoperative cognitive function in elderly patients undergoing general anesthesia. 中国当代医药, 2017, 24(17): 120-123.

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http://dangdaiyiyao.com/CN/ 或 http://dangdaiyiyao.com/CN/Y2017/V24/I17/120

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