不同麻醉方式对帕金森病患者术后认知功能的影响

发布时间：2018-12-17 21:05

【摘要】：目的探讨不同麻醉方式对帕金森病患者术后认知功能的影响。方法选择行下腹部或下肢手术的帕金森病患者48例,随机分入全凭静脉麻醉组(TIVA组)和蛛网膜下腔阻滞联合硬脊膜外腔阻滞麻醉组(CSEA组),每组24例。采用简易精神状态量表(MMSE)分别于术前1d和术后1、2、3、4、7d评估患者的认知功能。比较两组患者手术前后的MMSE评分。以性别、年龄、受教育时间、帕金森病Hoehn-Yahr分期、帕金森病病程、手术时间、手术类型、麻醉方式、麻醉时间、术中出血量、术前MMSE评分为自变量,以术后1d的MMSE评分为因变量,进行多元线性回归分析。结果两组间术前1d和术后2、3、4、7d的MMSE评分的差异均无统计学意义(P值均0.05),TIVA组术后1d的MMSE评分显著低于CSEA组同时间(P0.05)。两组术后1、2、3、4、7d的MMSE评分均显著低于同组术前1d(P值均0.01),术后1d的MMSE评分均显著低于同组术后2、3、4、7d(P值均0.01)。多元线性回归分析显示,麻醉方式(β=0.306,t=2.805,P=0.008)、帕金森病Hoehn-Yahr分期(β=-0.385,t=-3.104,P=0.004)、手术时间(β=-0.421,t=-1.088,P=0.043)、麻醉时间(β=-0.569,t=-0.759,P=0.041)、术前1d的MMSE评分(β=0.371,t=2.283,P=0.008)均为术后1d的MMSE评分的显著预测因素(R2=0.728,F=9.649,P0.05)。结论两种麻醉方式下帕金森病患者术后均出现认知功能改变,与全凭静脉麻醉比较,蛛网膜下腔阻滞联合硬脊膜外腔阻滞麻醉对患者认知功能的影响较小。
[Abstract]:Objective to investigate the effect of different anesthetic methods on postoperative cognitive function in patients with Parkinson's disease. Methods Forty-eight patients with Parkinson's disease undergoing lower abdominal or lower limb surgery were randomly divided into total intravenous anesthesia group (TIVA group) and subarachnoid block combined with epidural anesthesia group (CSEA group) with 24 cases in each group. The cognitive function of the patients was evaluated by mini-mental state scale (MMSE) on 1 day before operation and 3 days after operation. The MMSE scores before and after operation were compared between the two groups. According to sex, age, time of education, Hoehn-Yahr stage of Parkinson's disease, course of Parkinson's disease, operative time, type of operation, anaesthesia style, anesthetic time, intraoperative bleeding volume, preoperative MMSE score were independent variables. Multivariate linear regression analysis was performed with MMSE score 1 day after operation as dependent variable. Results there was no significant difference in the MMSE score between the two groups on the 1st day before operation and on the 2nd day after operation (P < 0.05). The MMSE score of the two groups was significantly lower than that of the CSEA group on the 1st day after operation (P0.05). The MMSE score of the two groups was significantly lower than that of the same group on the 1st day (P < 0.01) and the MMSE score on the 1st day after operation was significantly lower than that of the same group on the 7th day (P < 0.01). Multivariate linear regression analysis showed that anesthesia mode (尾 = 0.306), Hoehn-Yahr stage of Parkinson's disease (尾 = -0.385), operation time (尾 = -0.421), Hoehn-Yahr stage (尾 = -0.385), and operation time (尾 = -0.421), and parkinsonism stage (尾 = -0.385), and the duration of operation (尾 = -0.421), and parkinsonism stage (尾 = -0.385) and the duration of operation (尾 = -0.421). The MMSE score of 1 day before operation (尾 = 0.371t = 2.283) were significant predictors of MMSE score at 1 day after operation (R2O0.728F9.649P0.05), and the anesthesia time (尾 = -0.569t) and the preoperative MMSE score (尾 = 0.371t = 2.283) were significant predictors of the MMSE score on the 1st day after operation (尾 = -0.569t -0.759p 0.041). Conclusion compared with total intravenous anesthesia, subarachnoid block combined with epidural block has less effect on cognitive function of patients with Parkinson's disease.
【作者单位】：河北医科大学附属哈励逊国际和平医院疼痛科;河北医科大学附属哈励逊国际和平医院麻醉科;河北医科大学附属哈励逊国际和平医院神经内科;
【分类号】：R614

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