不同拔管方案对行全身麻醉老年患者术后认知功能的影响

    The influence of different extubation on the postoperative cognitive function in elderly patients with general anaesthesia

    • 摘要: 目的:观察不同拔管方案对行全身麻醉的老年患者术后认知功能的影响。方法:选择择期手术拟行气管插管全身麻醉的老年患者80例,随机分为瑞芬太尼-右美托咪定组(R组)和对照组(C组)各40例。均采用芬太尼-丙泊酚-罗库溴铵方案诱导,丙泊酚-瑞芬太尼-顺式阿曲库胺方案维持麻醉。手术结束后,R组入复苏室后予瑞芬太尼0.03 μg·kg-1·min-1和右美托咪定0.01 μg·kg-1·min-1持续泵注至拔管后5 min;C组入复苏室后予相同剂量0.9%氯化钠注射液持续泵注至拔管后5 min。所有患者于术前、术后第1天、第3天采用简易精神状态量表评价认知功能;并于术前、气管插管即刻、拔管即刻测血糖和血乳酸值。结果:2组患者术前认知功能评分差异无统计学意义(P >0.05),术后第1天和第3天R组患者认知功能评分均明显高于C组(P <0.01)。R组患者术前、术后第1天和第3天认知功能评分差异均无统计学意义(P >0.05);而C组患者术后第1天和第3天认知功能评分均显著低于术前(P <0.01)。 2组术前及气管插管即刻血糖和术前、气管插管和拔管即刻血乳酸差异均无统计学意义(P >0.05);R组术前、气管插管和拔管即刻血糖和血乳酸差异均无统计学意义(P >0.05),C组气管拔管即刻血糖均明显高于术前和气管插管即刻及R组(P <0.01),C组术前、气管插管和拔管即刻血乳酸差异均无统计学意义(P >0.05)。结论:采用瑞芬太尼-右美托咪定在拔管过程中持续输注,有助于降低对老年患者认知功能的影响。

       

      Abstract: Objective:To observe the influence of different extubation on the postoperative cognitive function in elderly patients with general anaesthesia.Methods:Eighty elderly patients scheduled by operation under general anaesthesia were randomly divided into the remifentanil-dexmedetomidine group(group R) and control group(40 cases each group).Two groups were induced using fentanyl- propofol-rocurunium bromide scheme,and maintained anaesthesia using propofol-remifentanil-cisatracuriumbesylate scheme.After operation,the group R patients were injected with 0.03 μg·kg-1·min-1 of remifentainil and 0.01 μg·kg-1·min-1 of dexmedetomidine until postextubation 5 minutes.The control group were injected with the same dose of 0.9% sodium chloride until postextubation 5 minutes.The congnitive functions of all patients at preoperation,and postoperative 1 and 3 days were assessed using the Mini-Mental State Examination,and the levels of blood glucose and blood lactic acid in two groups were detected at preoperation,intubation and extubation.Results:The difference of the congnitive function between two groups before operation was not statistically significant(P >0.05),and the scores of congnitive function in group R at postoperative 1 and 3 days were significantly higher than that in control group(P<0.01).The differences of the congnitive function scores in group R between preoperation,postoperative 1 and 3 days were not statistically significant(P >0.05),and the scores of congnitive function at postoperative 1 and 3 days were significantly lower than that before operation in control group(P<0.01).The differences of the blood glucose level between preoperation and intubation,and blood lactic acid level between intubation and extubation in two groups were not statistically significant(P >0.05).The differences of the levels of blood glucose and blood lactic acid between preoperation,intubation and extubation in group R were not statistically significant(P >0.05).The level of blood glucose in control group at extubation was significantly higher than that in control group at preoperation and intubation,and group R(P<0.01).The differences of the blood lactic acid levels at preoperation,intubation and extubation in control group were not statistically significant(P >0.05).Conclusions:The application of remifentainil and dexmedetomidine during extubation can decrease the influence of the postoperative cognitive function in elderly patients.

       

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