《中国康复理论与实践》

《中国康复理论与实践》 ›› 2014, Vol. 20 ›› Issue (6): 580-584.

• 论文 • 上一篇    下一篇

老年患者术后认知功能改变与全麻术中丙泊酚剂量的关系

甄宇，王敏，槐庆元，董鹏，田鸣，李树人   

  1. 首都医科大学附属北京友谊医院麻醉科，北京市100050
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2014-06-25 发布日期:2014-06-25

Relationship between Post-operative Cognitive Function Decline and Dose of General Anesthetic Propofol in the Elderly

ZHEN Yu,WANG Min, HUAI Qing- yuan, et al.   

  1. Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
  • Received:1900-01-01 Revised:1900-01-01 Published:2014-06-25 Online:2014-06-25

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摘要： 目的观察老年患者术后认知功能障碍(POCD)与全麻术中丙泊酚剂量的关系。方法将96 例择期行剖胸手术的患者随机分为高脑电双频谱指数(BIS)值组(HIBIS 组，BIS 50~60，丙泊酚低剂量组)和低BIS 值组(LOBIS组，BIS 30~40，丙泊酚高剂量组)。两组患者术中均持续输注瑞芬太尼0.2 μg/kg ⋅min，根据每组设定的BIS 值范围调整靶控输注丙泊酚血浆浓度。根据需要给予
相应的血管活性药维持平均动脉压在正常水平。记录术中丙泊酚总药量。术前1 d 和术后7 d 采用国际POCD研究协作组(ISPOCD)推荐的12 项认知测评量表对患者进行认知评估，并计算术前术后12 项测评分差。结果HIBIS 组47 例、LOBIS 组45 例进入研究。根据简易精神状态检查(MMSE)评分判断，HIBIS 组发生POCD 3 例(6.3%)，LOBIS 组1 例(2.2%)(P>0.05)；根据组合测试评分判断，HIBIS 组发生POCD 6 例(12.8%)，LOBIS组3 例(6.7%)(P>0.05)。HIBIS 组术后词语记忆评分较术前明显降低(P<0.01)；而两组术后词语延迟记忆、词语干扰和词语流畅评分均明显低于术前(P<0.01)。另外，两组患者12 项术后认知功能测评中，HIBIS组有4 项(数字连线、方向识别、数字广度和词语流畅)差值大于LOBIS组(P>0.05)。而HIBIS 组丙泊酚的平均总用药量明显低于LOBIS组(P<0.01)。结论在同等血流动力学水平及术中术后镇痛药用量的前提下，术中丙泊酚用量较多的老年患者术后认知功能减退的程度较小。

关键词: 术后认知功能障碍, 丙泊酚, 剂量, 老年

Abstract: Objective To explore the relationship between post-operative cognitive dysfunction (POCD) and the dose of general anesthetic propofol in the elderly. Methods 96 patients undergoing thoracic operation were selected and randomly assigned to high bispectral index (BIS) value (HIBIS 50~60, low dose of propofol) and low BIS value (LOBIS 30~40, high dose of propofol). Remifentanyl was infused in both group with the dose of 0.2 μg/kg &#8901; min. The dose of propofol was adjusted with target-controlled infuse (TCI) according to the different ranges of BIS value in different groups. The mean arterial pressure was maintained in a certain level. The dose of propofol was recorded during the operation. Cognitive function was assessed by 12 neurophysiological tests recommended by International Study of Post Operative Cognitive Dysfunction (ISPOCD) on the day before operation and the 7th day after operation. And the D-value of the tests before and after the operation was calculated. Results 47 cases in the HIBIS group and 45 cases in the LOBIS group were included in the end. The incidences of POCD were 6.3%(3 cases) and 2.2%(1 case) respectively in HIBIS group and LOBIS group according to Mini-Mental State Examination (MMSE) score, and 12.8% (6 cases) and 6.7% (3 cases) according to combination judgment, but there was no significantly difference (P>0.05). The post-operative scores were significantly lower than pre-operative scores (P<0.01) on Hopkins Verbal Learning Test-Revised (HVLT-R) in HIBIS group. and HVLT-R dealyed Recall Test, Hvlt- r Recognition Discrimination Index and Verbal Fluency Test in both groups (P<0.01), including verbal and words. The D-values of 4 neurophysiological tests were higher in the HIBIS group than in the LOBIS group. The dose of propofol was significantly lower in the HIBIS group than in the LOBIS group (P<0.01). Conclusion As the same level of analgisia and hemodynamics, the more the dose of propofol is, the better the post-operative function is in the elderly.

Key words: post-operative cognitive dysfunction, propofol, dose, elderly