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两种麻醉方式对帕金森病患者术后谵妄和认知功能的影响
The Observation of the Impact of Two Different Anesthesia Methods on Postoperative Delirium and Cognitive Function in Parkinson Disease Patients
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DOI:
作者:
刘志永 丁翠青 姚长青 靳红绪 王福朝
LIU Zhiyong*,DING Cuiqing, YAO Changqing*, JIN Hongxu* ,WANG Fuchao*
作者单位:
河北省衡水市哈励逊国际和平医院
Harrison International Peace Hospital
关键词:
【关键词】 麻醉;帕金森病;谵妄;认知功能障碍;手术后期间
【Key words】 Anesthesia; Parkinson disease; Delirium; Cognitive dysfunction; Postoperative period
摘要:
【摘要】 目的 观察并分析腰麻-硬膜外联合麻醉和全凭静脉麻醉对帕金森病患者术后谵妄和认知功能的影响。方法 选择行下腹部或下肢手术的帕金森病患者46例,随机分为全凭静脉麻醉组(TIVA组)和腰麻-硬膜外联合麻醉组(CSEA组),两组各23例,采用谵妄评定量表(CAM-CR)、简易精神状态量表(MMSE)分别于术前1d、术后1d、2d、3d、4d、7d 6个时间点评估患者谵妄状态和认知功能。使用成组t检验、配对样本t检验和重复测量的方差分析对评分进行统计分析,并比较两组间以及组内评分差异。结果 两组间比较 两组患者的一般资料无显著差异(P值均>0.05)。 重复测量的方差分析结果显示,两组间CAM-CR和MMSE评分均随时间点变化而改变(P值均<0.01),麻醉方式与时间点间均有交互作用(P值均<0.01)。术后1d,TIVA组CAM-CR评分显著高于CSEA组(P=0.001);而MMSE评分显著低于CSEA组(P=0.034)。两组间其余时间点的CAM-CR、MMSE评分均未见显著差异(P值均>0.05)。组内的比较 CAM-CR评分:两组术后1d、2d、3d、4d、7d评分均高于术前1d (P值均<0.01);术后2d评分均高于术后1d(P值均<0.05);术后2d评分高于术后3d,但无统计学意义(P值均>0.05);术后4d评分均低于术后3d(P值均<0.01);术后7d评分均低于术后4d(P值均<0.01)。MMSE评分:两组中,术后1d、2d、3d、4d、7d评分均低于术前1d (P值均<0.01);术后1d评分均低于术后2d、3d、4d、7d(P值均<0.01);术后3d评分均高于术后2d (P值均<0.01);术后4d评分均高于术后3d (P值均<0.01);术后7d评分均高于术后4d (P值均<0.01)。结论 麻醉和手术对帕金森病患者的术后谵妄评分和认知功能产生一定影响,且其影响分别在术后1d,2d最为显著。两种麻醉方式对帕金森病患者术后谵妄和认知功能的影响短期内有一定的差异,术后1d最为显著,但长期未见明显差异。
【Abstract】 Objective To investigate the impact of combined spinal-epidural anesthesia (CSEA) and total intravenous anesthesia (TIVA) on postoperative delirium and cognitive function in patients with Parkinson disease. Methods 46 patients with Parkinson disease who had either lower extremity or lower abdominal surgery were divided into two groups: combined spinal-epidural anesthesia group (CSEA group) and total intravenous anesthesia (TIVA group), and each group had 23 patients. The status of delirium and cognitive function was measured respectively with Confusion Assessment Method Chinese-Reversion (CAM-CR) and Mini-Mental State Examination (MMSE) at 6 time points (preoperative 1d and postoperative 1d, 2d, 3d, 4d, 7d) in both groups. Data collected were analyzed with independent-samples T test, paired-samples T test and repeated measurements analysis of variance to discover the difference between two groups and difference within each group. Results The repeated measurements analysis of variance showed the scores of CAM-CR and MMSE in both groups changed with time points (P<0.01). There was interaction between anesthesia method and time point for each score (P<0.01). The scores of CAM-CR in TIVA group were higher than group CSEA in postoperative 1d (P=0.001), and there were no significant difference in other time points between the two groups (P>0.05). The scores of MMSE in TIVA group were lower than group CSEA in postoperative 1d (P=0.034), and there were no significant difference at other time points between two groups (P>0.05) too. The scores of CAM-CR in postoperative days were higher than preoperative 1d respectively (p<0.01) in both groups, and postoperative 2d were both higher than postoperative 1d, the postoperative 2d were both higher than postoperative 3d, but there was no statistical difference (P>0.05). Furthermore, the scores of postoperative 4d were both lower than postoperative 3d (P<0.01), and postoperative 7d were lower than postoperative 4d (P<0.01). The scores of MMSE in postoperative days were lower than preoperative 1d respectively (P<0.01) in both groups. The postoperative 2d were higher than postoperative 1d (P<0.01) in both groups, the postoperative 2d were both higher than postoperative 3d (P<0.01), the postoperative 4d were both higher than postoperative 3d (P<0.01) and postoperative 7d were higher than postoperative 4d (P<0.01), respectively. Conclusion Patients with Parkinson disease who undergo anesthesia and surgery may suffer the change of delirium and cognitive function in those postoperative days, and the change is most profound in postoperative 1d, 2d respectively. The difference of the impact of two anesthesia methods on postoperative delirium and cognitive function in Parkinson disease patients is notable in short time, especially in postoperative 1d, but there is no difference in long period.
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