| 摘要: |
| 目的 比较全身麻醉单纯应用七氟烷、七氟烷复合丙泊酚及七氟烷复合右美托咪定对患者术后认知功能的影响。方法 选择择期行腹腔镜子宫肌瘤切除术的患者90例，年龄为18~65岁，美国麻醉医师协会（ASA）分级为Ⅰ级或Ⅱ级。采用随机数字表法将90例患者分为3组：七氟烷组、七氟烷复合丙泊酚组和七氟烷复合右美托咪定组，每组30例。3组患者麻醉诱导药物相同。七氟烷组患者以1~1.2最低肺泡有效浓度（MAC）七氟烷维持；七氟烷复合丙泊酚组以0.5 MAC七氟烷维持，并靶控输注丙泊酚（目标血药浓度为2~3 μg/mL）；七氟烷复合右美托咪定组以0.5 MAC七氟烷维持，并静脉泵注右美托咪定负荷剂量1 μg/kg（泵注10 min），然后按照0.2 μg/（kg·h）的剂量持续泵注右美托咪定至手术结束前30 min。分别于术前1 d和术后7 d测试3组患者的认知功能，并于术前和术后24 h测定血浆水平。结果 3组患者的年龄、体质量指数、术前简易智力状态检查量表评分、手术时间和出血量差异均无统计学意义（P均>0.05）。七氟烷复合右美托咪定组患者术后7 d的霍普金斯视觉学习测试（HVLT1）和数字广度测试（FSDT）评分[（23.22±4.75）分、（2.39±0.69）分]均高于七氟烷组[（21.00±4.96）分、（2.17±0.39）分]，但低于七氟烷复合丙泊酚组[（24.89±6.20）分、（2.84±0.96）分]，差异均有统计学意义（P均<0.05）。七氟烷复合右美托咪定组患者术后24 h血浆白细胞介素6（IL-6）水平[（19.93±10.04）pg/mL]低于七氟烷组[（36.06±17.03）pg/mL]、七氟烷复合丙泊酚组[（39.99±19.39）pg/mL]，差异均有统计学意义（P均<0.05）。结论 与全身麻醉单纯应用七氟烷、七氟烷复合丙泊酚相比，全射麻醉应用七氟烷复合右美托咪定的患者有更好的术后认知功能，其可能与术后IL-6的低水平有关。 |
| 关键词: 全身麻醉 右美托咪定 七氟烷 丙泊酚 白细胞介素6 |
| DOI：10.16781/j.0258-879x.2019.12.1393 |
| 投稿时间：2019-05-12修订日期：2019-06-12 |
| 基金项目:国家自然科学基金青年科学基金（81600934），上海市科学技术委员会科研计划项目（16411967700，16ZR1432200）. |
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| Comparison of postoperative cognitive function in patients undergoing general anesthesia using sevoflurane alone, sevoflurane plus propofol and sevoflurane plus dexmedetomidine |
| YANG Jun-jun,ZHAO Yan-hong,LIU Jian-hui* |
(Department of Anesthesiology, Tongji Hospital, Tongji University, Shanghai 200065, China
*Corresponding author) |
| Abstract: |
| Objective To compare the postoperative cognitive function of patients undergoing general anesthesia using three strategies:sevoflurane alone, sevoflurane plus propofol, and sevoflurane plus dexmedetomidine. Methods Ninety patients aged 18 to 65 years who were scheduled to undergo laparoscopic hysteromyomectomy were selected for this study. The American Society of Anesthesiologists (ASA) was classified as Grade Ⅰ or Grade Ⅱ. Ninety patients were divided into three groups by random number table:sevoflurane group, sevoflurane-propofol group and sevoflurane-dexmedetomidine group, with 30 patients in each group. The induction drugs of anesthesia were the same in the three groups. Sevoflurane group was maintained with 1-1.2 minimum alveolar concentration (MAC) sevoflurane; sevoflurane-propofol group was maintained with 0.5 MAC sevoflurane and target controlled infusion propofol (target blood concentration was 2-3 μg/mL); and sevoflurane-dexmedetomidine group was maintained with 0.5 MAC sevoflurane, intravenous pump loading dose of dexmedetomidine was 1 μg/kg (pump infusion for 10 min), and dexmedetomidine was continuously pumped at a dose of 0.2 μg/(kg·h) until 30 min before the end of the operation. Cognitive function was measured 1 d before operation and 7 d after operation, and plasma levels of inflammatory factors were measured before operation and 24 h after operation. Results There were no significant differences in age, body mass index, preoperative score of mini-mental state examination scale, operation time or blood loss among the three groups (all P>0.05). The Hopkins visual learning test (HVLT1) and forward digit span test (FSDT) scores 7 d after operation (23.22±4.75, 2.39±0.69) were significantly higher in the sevoflurane-dexmedetomidine group than those in the sevoflurane group (21.00±4.96, 2.17±0.39), but lower than those in the sevoflurane-propofol group (24.89±6.20, 2.84±0.96), and the differences were statistically significant (all P<0.05). The plasma interleukin 6 (IL-6) level ([19.93±10.04] pg/mL) in the sevoflurane-dexmedetomidine group was significantly lower than those in the sevoflurane group ([36.06±17.03] pg/mL, P<0.05) and sevoflurane-propofol group ([39.99±19.39] pg/mL, P<0.05). Conclusion Compared with sevoflurane alone and sevoflurane plus propofol, patients with sevoflurane plus dexmedetomidine for general anesthesia have better postoperative cognitive function, which may be related to the low level of IL-6 after surgery. |
| Key words: general anesthesia dexmedetomidine sevoflurane propofol interleukin 6 |
