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神经介入手术患者术后早期认知功能障碍和脑氧饱和度的关系
The relationships of the cerebral oxygen saturation and early postoperative cognitive dysfunction in patients undergoing interventional neuroradiology procedures.

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DOI:
作者:
张马忠
LIU Fan, LIU Zhong-guang, LI Yong-wang, MA Yu-heng
作者单位:
辽宁医学院中国人民解放军第二炮兵总医院研究生培养基地
Department of Anesthesia, The second Artillery General Hospital PLA, Beijing 100088, China
关键词:
七氟烷；丙泊酚；术后认知功能障碍；脑氧饱和度；神经介入术
Sevoflurane; Propofol; Postoperative cognitive dysfunction; Cerebral oxygen saturation; Interventional neuroradiology procedure
摘要:
目的 基于脑氧饱和度监测，比较不同全麻维持方式对神经介入手术患者术后早期认知功能的影响并探索两者间的关系。方法 择期全麻神经介入手术的缺血性脑血管病患者40例，根据麻醉维持期使用药物的不同分为丙泊酚组（P组，丙泊酚复合瑞芬太尼）和七氟烷组（S组，七氟烷复合瑞芬太尼）。术中连续监测患者脑氧饱和度（SctO2）以及生命体征，采用简易精神状态检查量表(Mini-Mental State Exam, MMSE)评估患者认知功能。记录术中血管活性药物使用量、苏醒情况、术中体动及苏醒期躁动情况。结果S组患者苏醒情况优于P组，脑氧饱和度下降的相对值更小，术后6小时认知功能障碍的发生率更低，且术后认知功能障碍的发生与脑氧饱和度下降持续的时间长短呈直线相关关系，术中追加血管活性药物的量更少，而两组患者发生体动、苏醒期躁动情况差异无统计学意义。结论 神经介入手术中，患者术后早期认知功能障碍的发生与脑氧饱和度下降有关，采用七氟烷维持麻醉的患者术后清醒更快,术后认知功能障碍的发生概率比丙泊酚维持者低。
Objective To investigate the influence of anesthesia maintenance with propofol or sevoflurane on the incidence of postoperative cognitive dysfunction (POCD) based on the cerebral oxygen saturation monitoring in patients undergoing interventional neuroradiology procedures. Methods Forty patients undergoing interventional neuroradiology procedures were divided randomly into two groups. After intubation, the propofol group (group P) received propofol and remifentanil. The sevoflurane group (group S) received sevoflurane and remifentanil. The cerebral oxygen saturation monitoring was established and vital signs were recorded. The Mini-Mental State Exam (MMSE) test was used to assess cognitive function before operation and at 6 and 24 h after operation. The recovery times, the amount of phenylephrine, the number of patients with movement or emergence agitation were recorded. Results The group S had a more rapid recovery to spontaneous ventilation, eye opening, extubation and orientation compared with group P. In the group P, greater amount phenylephrine was used, but the number of patients with movement or emergence agitation were similar. Early postoperative cognitive dysfunction was significantly lower with sevoflurane compared with propofol 6 hours after the surgery. The relative SctO2 maximum decrease of group P was more than group S and there was a fine linear correlation between the POCD and the exposure time of the relative SctO2 maximum decrease rather than the value of the relative SctO2 maximum decrease. Conclusions Anesthesia maintaine with sevoflurane for patients undergoing the interventional nuroradiology procedures is associated with the faster recovery, better preserved SctO2 and reduced early cognitive dysfunction compared with propofol.

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