摘要
目的：观察右美托咪定和七氟醚对心脏瓣膜置换术患者术后认知功能的影响。方法：选择全麻下行心脏瓣膜置换术的心脏病患者60例,美国麻醉医师协会（ASA）评分Ⅲ～Ⅳ级,随机的分为右美托咪定组和七氟醚组;右美托定组持续泵注右美托咪定至术毕,七氟醚组全程持续吸入七氟醚,麻醉维持均使用七氟醚、舒芬太尼以及维库溴铵维持麻醉深度,将熵指数控制在40～60;分别于术前1天、术后第3和第7天使用蒙特利尔认知功能量表（Mo CA）和简易精神状态量表（MMSE）对患者认知功能状态进行评估。结果：两组患者体外循环（CPB）时间、阻断升主动脉时间、手术时间以及出血量比较,差异无统计学意义（P〉0.05）;两组术前1天、术后第3及7天的Mo CA及MMSE量表得分分别比较,差异无统计学意义（P〉0.05）;两组患者术后第3天和第7天分别与术前1天相比,Mo CA得分降低（P〈0.05）;两组患者术后第3天和第7天分别与术前1天相比,MMSE得分差异无统计学意义（P〉0.05）。结论：右美托咪定用于体外循环心脏瓣膜置换术效果与七氟醚相当,能降低患者术后认知功能的下降情况,Mo CA评价术后认知功能改变的敏感性优于MMSE。
Objective： To observe the effects of dexmedetomidine and sevoflurane on postoperative cognitive function of patients undergoing cardiac valve replacement. Methods： 60 patients with heart disease undergoing operation of cardiac valve replacement with general anesthesia were enrolled in this study. According to ASA III- IV grade, they were randomly divided into two groups： dexmedetomi- dine group （group D, n = 30） and sevoflurane group （group S, n = 30）. Group D received continuous infusion of dexmedetomidine until the end of operation while Group S inhaled sevoflurane through the whole operation. Sevoflurane and sufentanil were used for maintenance of anesthesia, and vecuronium was used to maintain anesthesia depth. The entropy index was controlled in 40 - 60. The cognitive function scale （MoCA） and the Mini Mental State Scale （MMSE） were used to evaluate the cognitive function of patients at the I st day before surgery, the 3to day after surgery and the 7th day after surgery, respectively. Results： There was no statistically significant difference between the two groups in the time of cardiopulmonary bypass （CPB） , the time of ascending aorta, the operation time and the amount of bleeding （P 〉 0.05 ） ; There was no statistically significant difference in MoCA and MMSE between the two groups at the 1 st day before surgery, the 3rd day after surgery and the 7th day after sur- gery, respectively. Compared with 1st day before surgery, at the 3rd day after surgery and at the 7th day the score of MoCA decreased and the diffmnce was statistically significant （P 〈 0.05）. However, compared with 1st day before surgery, there was no statistically significant difference in MMSE between the two groups at the 3rd day after surgery and at the 7th day （ P 〉 0.05 ）. Conclusion ： The effect dexmedetomidine used for cardiac valve replacement surgery of cardiopumonary bypass is nearly the same as sevoflurane, and can reduce postoperative cognitive function decline.
出处
《贵阳医学院学报》
CAS
2016年第9期1057-1060,共4页
Journal of Guiyang Medical College
基金
贵州省社会发展攻关项目[黔科合SY字(2012)3111]
贵阳市科技计划[筑科合同(2013103)33号]
关键词
右美托咪定
七氟醚
蒙特利尔认知功能评估量表
体外循环
认知功能障碍
dexmedetomidine
sevoflurane
Montreal cognitive function assessment scale
cardiopu-monary bypass
cognitive dysfunction
