冠状动脉搭桥术后患者并发认知功能障碍的危险因素

目的探讨冠状动脉搭桥术后患者并发认知功能障碍(POCD)的危险因素。方法选择2019年1月～2021年1月我院收治的110例采用冠状动脉搭桥术治疗的冠心病患者为研究对象,术后采用简易精神状态评价量表(MMSE)进行POCD筛查,并设为POCD组与非POCD组。比较两组患者年龄、合并糖尿病等一般资料以及手术时间、术中脑氧饱和度(r SO₂)变化率等手术资料,先后运用单因素与多因素回归分析探讨术后并发POCD的危险因素。结果110例冠状动脉搭桥术后26例患者并发POCD,发生率23.64%;POCD组与非POCD组在年龄、合并糖尿病、术中r SO₂变化率、体外循环、术前焦虑、ICU时间差异具有统计学意义(P<0.05),两组性别、受教育程度、手术时间差异无统计学意义(P>0.05);多因素Logistic回归分析显示,年龄>70岁、术中r SO₂变化率>30%、体外循环、术前焦虑、ICU时间>7d是冠状动脉搭桥术后并发POCD的独立危险因素。结论冠状动脉搭桥术后POCD发生率较高,与年龄、r S...     

烟雾病血管搭桥术中脑氧供需平衡监测

目的 探讨局部脑氧饱和度(rSO2)监测在烟雾病患者行脑血管搭桥术中反映脑氧供需平衡的临床应用价值.方法 17例缺血型烟雾病患者,ASA Ⅰ ～Ⅱ级,Suzuki≥Ⅲ级,在丙泊酚-瑞芬太尼麻醉下行脑血管搭桥手术.术中常规监测动脉压(MAP)、心率(HR)、脉搏血氧饱和度( SpO2)、呼气末二氧化碳分压(PetCO2)、脑电双频指数(BIS)、体温(T)、局部脑氧饱和度(rSO2)及记录动静脉血气分析数据,并根据Fick原理计算脑动脉-颈内静脉球氧含量差(Ca - vDO2).术中维持BIS在40 ～50,按随机顺序调节呼吸参数,分别将PaCO2控制在30、40、50 mmHg水平,稳定10 min后记录上述监测指标.结果 术中MAP、HR、Hb、BIS、T、PaO2无显著变化.rSO2和颈静脉球氧饱和度(SjvO2)随着PaCO2的增减而升高或下降(P＜0.01);Ca - vDO2随着PaCO2的增减而降低或升高(P ＜0.05);rSO2与SjvO2呈明显正相关(r=0.745,P=0.000),而rSO2与Ca - vDO2呈显著的负相关(r=-0.64,P=0.000).结论 烟雾病患者行脑血管搭桥术中,rSO2监测能够及时准确反映额叶脑血流及氧供需平衡的变化,预防术中脑缺血等不良事件的发生.     

脑电仿生电刺激对脑梗死后认知功能障碍的影响

目的观察脑电仿生电刺激小脑顶核对脑梗死后认知功能障碍的影响,并探讨其可能的机制。方法选取脑梗死后并发认知功能障碍患者50例,随机分成治疗组与对照组各25例。2组患者均接受康复治疗及认知功能训练,治疗组同时加用脑电仿生电刺激进行干预。2组患者分别于治疗前后应用蒙特利尔认知评估量表(MoCA)、简易精神状态量表(MMSE)评定认知功能变化,采用经颅多普勒超声(TCD)评估颅内动脉血流动力学改变。结果治疗后2组患者MoCA评分、MMSE评分均较组内治疗前提高(P<0.05),且治疗组评分明显较对照组高,差异有统计学意义(P<0.05)。治疗后2组患者颅内动脉血流动力学较组内治疗前改善(P<0.05),且治疗组较对照组改善更显著,差异有统计学意义(P<0.05)。治疗组与对照组总有效率分别为92%和64%,差异有统计学意义(P<0.05)。结论脑电仿生电刺激小脑顶核可有效改善脑梗死患者的认知功能,其可能机制是通过改善患者的脑循环进一步改善认知功能。     

老年髋关节置换术患者术后认知功能障碍的临床特点及影响因素分析

目的研究65岁以上行髋关节置换术患者术后认知功能障碍的临床特点及影响因素。方法 101例患者在术前1 d~3 d和术后7 d进行MMSE量表测定,收集患者的一般资料、年龄、性别、受教育时间、既往病史、手术时间、失血量、麻醉方式。采用多因素Logistic逐步回归分析POCD发生的影响因素,P0.05为差异有统计学意义。结果 101例患者发生POCD者16例,发生率为15.84%,POCD组患者的年龄显著大于非POCD组(OR=1.238,95%CI 1.103~1.248,P0.05),POCD组中全麻患者显著多于非POCD组(OR=1.215,95%CI 1.003~8.72,P0.05)。结论临床工作中对于高龄、全麻的髋部骨折患者应该多关注术后认知功能变化,及时进行相关量表筛查,尽早发现、尽早干预。     

动脉瘤性蛛网膜下腔出血患者开颅夹闭术与介入栓塞术后认知功能的对比研究

目的探讨开颅夹闭术与介入栓塞术对动脉瘤性蛛网膜下腔出血(SAH)患者认知功能的影响。方法分析2015年7月—2017年12月,行开颅夹闭术或介入栓塞术治疗的122例动脉瘤性蛛网膜下腔出血患者的临床资料。采用简易精神状态检查(MMSE)量表对所有患者的认知功能进行评定;每例患者共进行4次MMSE评分:入院时(治疗前)、术后近期(术后2周)、中期(术后2个月)、远期(术后1年)。将患者按照手术治疗方式分为开颅夹闭组(42例)和介入栓塞组(80例),分别对比两组患者术前、近期、中期和远期的MMSE评分;并对不同时期认知功能障碍发生率进行比较。结果两组患者术前MMSE评分的差异无统计学意义(P>0.05);介入栓塞组在术后早期、中期及远期的MMSE评分均明显高于开颅夹闭组(均P<0.05)。开颅夹闭组患者在术后近期及中期的认知功能障碍发生率均明显高于介入栓塞组(均P<0.05);但在术后远期,两组患者认知功能障碍发生率的差异无统计学意义(P>0.05)。结论行开颅夹闭术的动脉瘤性蛛网膜下腔出血患者,术后近期及中期的认知功能障碍发生率明显高于介入栓塞术患者。介入栓塞治疗动脉瘤有助于减轻认知功能的损害。     

事件相关电位在轻度认知功能障碍诊断中的意义

目的探讨轻度认知功能障碍和阿尓茨篋〉氖录喙氐缥?ERP:N100、P300)变化。方法根据Peterson制订的MCI诊断标准,筛选出21例MCI患者(MCI组),22例正常对照者(NC组)以及20例阿尓茨篋?AD)组患者,分别用英国OXFORD脑电生理仪记录事件相关电位(ERP:N100,P300)和视觉诱发电位(VEP)情况。结果(1)AD组MMSE评分(16.52±2.17分)及MCI组(24.33±1.34分)低于正常对照组[(26.57±1.43)分,P<0.01]。(2)AD组与MCI组靶波幅P3和非靶波幅P2均见降低,与NC组比较也有显著性差异(P<0.05、P<0.01)。(3)N100潜伏期、波幅变化不是很大(P>0.05)。(4)AD组P300靶刺激中的P2、P3波潜伏期与MMSE分值呈负相关(P<0.05、P<0.01)。结论AD和MCI患者的P300有多项指标异常对于临床诊断AD和MCI患者有一定价值。事件相关电位与认知功能存在明显相关性,提示事件相关电位可以客观反映AD和MCI患者的认知功能障碍。     

急性脑梗死患者事件相关电位及其与认知功能的相关性

目的分析脑梗死患者的事件相关电位与认知障碍的关系。方法应用简易精神状态检查量表(MMSE)和相关事件电位(ERP)的检测,分析脑梗死患者的认知功能变化与P300的关系。结果脑梗死组MMSE评分低于正常对照组(P<0.01),P300潜伏期高于正常对照组,振幅低于正常对照组(P<0.05)。脑梗死组P300潜伏期与年龄(r=0.477,P<0.05)成正相关,与学历(r=-0.516,P<0.05)、MMSE(r=-0.549,P<0.05)、功能独立性评定量表(FIM)认知项呈负相关(r=-0.584,P<0.01),而与抑郁、性别、神经功能缺损评分、MBI、既往史评分、伴发病评分等因素不相关。结论听觉P300潜伏期可以客观反映急性脑梗死患者的认知功能障碍。     

颅脑损伤患者不同部位颅内压监测与治疗效果的 相关性

目的 探讨颅脑损伤患者不同部位颅内压监测与治疗效果的关系。方法 将82例重型颅脑 损伤患者按照有无颅内压监测分为非监测组和监测组，监测组分为脑室内监测组和脑实质内监测组，观察 不同组别的治疗效果。结果 术后第7天脑室内监测组颅内压低于脑实质内监测组［（10.35±3.32）mmHg 比（13.46±4.71）mmHg；t=4.017，P=0.028］。脑室内监测组甘露醇使用时间（6.05±2.03）d以及剂量 （748.92±126.65）g低于脑实质内监测组［（8.46±2.41）d，（961.72±128.82）g；t=3.011，5.254，P ＜ 0.05］。 术后第7天、第14天脑室内监测组GCS评分［（9.11±2.73），（12.06±2.37）分］高于脑实质内监测组 ［（8.82±2.67），（10.09±2.23）分；t=3.403，4.562；P＜0.05）］。随访患者6个月，其中监测组总有效率（75.86%， 68.97%）均显著高于非监测组（41.67%），差异有统计学意义（χ2=5.432，6.401；P＜ 0.05）；脑室内监测组脑 积水发生率（10.34%）显著低于脑实质内监测组（3.45%）、非监测组（4.17%），差异有统计学意义（χ2=3.709， 4.421；P＜ 0.05）。结论 脑室内颅内压监测能明显降低重型颅脑损伤患者甘露醇使用、较快降低颅内高 压，预后情况良好，并发症少，值得临床应用，脑实质内监测次于脑室内监测。     

显微夹闭术与介入栓塞术对颅内动脉瘤患者术中脑氧代谢及预后的影响

目的 对比研究颅内动脉瘤显微夹闭术与介入栓塞术对颅内动脉瘤患者围术期脑氧代谢的影响以及对患者短期预后的影响。方法 择期手术颅内动脉瘤患者36例,根据不同手术方式分为动脉瘤显微夹闭组（A组）与介入动脉瘤栓塞组（B组）,各18例。经颈内静脉逆行置管后,分别于麻醉置管后即刻（T1）、动脉瘤处理前（T2）、动脉瘤处理后即刻（T3）及术毕（T4）4个时间点采取外周动脉血和横窦静脉血做血气分析,监测并比较两组脑氧代谢结果,比较两组患者预后情况。结果 B组内与T1比较,T4的横窦静脉血氧饱和度（SsvO2）明显下降,动脉血乳酸浓度（aLAC）明显升高,差异具有统计学意义（P <0.05）。与A组比较,B组T2所对应的动静脉氧含量差（Da-svO2)、脑氧摄取率（CERO2）增加,术后是否入重症监护室（ICU)、术后住院时间以及相关有创操作明显减少,差异具有统计学意义（P <0.05)。两组出院6个月内的改良RANKIN量表（mRS评分）比较,差异具有统计学意义（P <0.05),B组明显优于A组。结论 与显微夹闭术治疗颅内动脉瘤比较,介入栓塞术中对脑氧供需平衡影响较大,但患者短期预...     

丙泊酚和七氟烷麻醉对老年胸外科手术患者术后认知功能的影响分析

目的探讨丙泊酚麻醉和七氟烷麻醉对老年胸外科手术患者术后认知功能的影响。方法选择医院2015年6月-2016年6月收治的110例老年胸外科手术患者作为研究对象,按照数字表法随机分为观察组和对照组,每组各55例患者。观察组给予丙泊酚联合舒芬太尼麻醉,对照组给予七氟烷联合舒芬太尼麻醉,比较两组患者术后认知功能障碍(POCD)发生率,并对认知功能产生的影响因素进行分析。结果两组患者手术时间和麻醉时间无明显差异(P0.05);观察组自主呼吸恢复时间、睁眼时间、拔管时间和应答时间均少于对照组(P0.05);术后1h,6h,12h观察组简易精神量表(MMSE)评分均高于对照组(P0.05),观察组术后12h MMSE评分恢复至术前水平,对照组术后24h恢复至术前水平。观察组术后不良反应发生率为14.55%,对照组不良反应发生率为30.91%,观察组明显低于对照组(P0.05);术后1h,6h,合并基础疾病患者POCD发生率明显高于无基础疾病患者。结论丙泊酚和七氟烷麻醉都会导致老年胸外科手术患者术后短期内认知功能的下降,均会引起POCD的发生,但丙泊酚麻醉对认知功能的影响较小,术后认知功能恢复更早。     

Loewenstein认知评定量表与简易精神状态量表对心脏手术患者认知功能评估的比较

目的 通过与简易精神状态量表(MMSE)的比较,评估Loewenstein认知评定量表(LOTCA)是否能用于术后认知障碍(POCD)的诊断与研究. 方法 对山东省立医院心外科自2010年10月至2011年3月行心脏瓣膜置换术的30例患者,分别于术前1d和术后7d使用MMSE、LOTCA行神经心理学测评患者的认知功能,分析比较二者对POCD的诊断率、MMSE和LOTCA评分及检测时间的差异. 结果 患者采用MMSE测评诊断POCD 13例(43.33％),采用LOTCA测评诊断POCD 17例(56.67％),诊断率比较差异无统计学意义(x2=1.067,P=0.302).与术前1d比较,术后7d患者MMSE总分、LOTCA总分、LOTCA评分中4个子项目(动作运用、视运动组织、思维操作、注意力及专注力)得分降低,差异均有统计学意义(P＜0.05).患者MMSE总分与LOTCA总分呈正相关关系(γ=0.711,P=0.005).与MMSE的测评时间比较、患者术前1d和术后7d LOTCA的测评时间均较高,差异有统计学意义(P＜0.05). 结论 LOTCA可以用于POCD的诊断与研究,能够较MMSE更全面的评估患者的认知功能,但耗时较长.     

Neuroprotection of hyperbaric oxygen therapy in sub-acute traumatic brain injury：not by immediately improving cerebral oxygen saturation and oxygen partial pressure

Although hyperbaric oxygen (HBO) therapy can promote the recovery of neural function in patients who have suffered traumatic brain injury (TBI), the underlying mechanism is unclear. We hypothesized that hyperbaric oxygen treatment plays a neuroprotective role in TBI by increasing regional transcranial oxygen saturation (rSO2) and oxygen partial pressure (PaO2). To test this idea, we compared two groups:a control group with 20 healthy people and a treatment group with 40 TBI patients. The 40 patients were given 100% oxygen of HBO for 90 minutes. Changes in rSO2 were measured. The controls were also examined for rSO2 and PaO2, but received no treatment. rSO2 levels in the patients did not differ signiifcantly after treatment, but levels before and after treatment were signiifcantly lower than those in the control group. PaO2 levels were signiifcantly decreased after the 30-minute HBO treatment. Our ifndings suggest that there is a disorder of oxygen metabolism in patients with sub-acute TBI. HBO does not immediately affect cerebral oxygen metabolism, and the underlying mechanism still needs to be studied in depth.     

颅内压监测在治疗非脑疝高血压脑出血中的应用及疗效分析

目的探讨颅内压（ICP）监测对非脑疝高血压脑出血患者手术方式选择的指导价值及术后疗效分析。 方法选取新疆医科大学第一附属医院神经外科中心自2018年2月至10月治疗的73例非脑疝高血压脑出血患者，根据术前是否行脑内ICP监护仪探头置入术将其分为监护组（37例）和对照组（36例）。监护组根据ICP值结合患者术前CT选择手术方式，术后制定甘露醇用法用量；对照组仅根据患者临床表现及术前CT决定手术方式，术后经验性使用甘露醇。比较2组患者的手术方式、术后并发症的发生率及预后。 结果监护组患者术后甘露醇使用总剂量低于对照组，住院时间短于对照组，差异均有统计学意义（P<0.05）。监护组患者术后并发胃肠道出血、肺部感染、深静脉血栓、气管切开、二次手术去骨瓣的发生率为21.6%，低于对照组（55.6%）；监护组术后6个月日常生活能力等级为Ⅰ~Ⅱ级的患者概率（81.08%）高于对照组（55.56%），差异均具有统计学意义（P<0.05）。 结论术前对非脑疝高血压脑出血患者先行ICP监测，能客观指导手术方式的选择，对减少术后并发症、避免因术后脑水肿而激进性去骨瓣手术有意义，对患者术后加速康复和提高长期生活质量有很大帮助。     

Pseudoparadoxical dissociation of cerebral oxygen saturation and cerebral blood flow velocity after acupuncture in a woman with cerebrovascular dementia: a case report

Acupuncture can increase both cerebral oxygen saturation and cerebral blood flow velocity. We describe a 77-year-old woman with cerebrovascular dementia in whom acupuncture reproducibly induced an increase of blood flow velocity but a decrease of regional oxygen saturation. At four of 11 acupuncture sessions, blood flow velocity was measured in the middle cerebral artery with transcranial Doppler sonography and cerebral regional oxygen saturation (rSO(2)) with transcranial near infrared spectroscopy. Cerebral blood flow velocity increased by an average of 20% (range: 7-27%) at all four study points whereas rSO(2) consistently decreased by an average of 7% (range: 4-13%). Clinical status and cognitive function improved. These findings in a patient with vascular dementia may suggest increased oxygen extraction by activated neuronal structures.     

Noninvasive assessment of cerebral oxygenation during high altitude trekking in the Nepal Himalayas (2850-5600 m)

Mountain trekking is significantly increasing in popularity. Hypoxia seems to play a key role in the pathogenesis of acute mountain sickness (AMS). The purpose of this study was to investigate regional cerebral (rSO2) and peripheral (SaO2) oxygen saturation for the first time, during 22 days high altitude trekking (measurement points: 3450, 4450, 4750, 5050 and 2850 m) in the Khumbu region of Nepal with near infrared spectroscopy and pulse oximetry. We examined 17 healthy volunteers 19-65 years old (8 female, 9 male; mean age +/- SD, 46.1 +/- 13.1 years). RSO2 and SaO2 were significantly (p < 0.001, ANOVA, Tukey test) decreased at high altitudes (4450, 4750 and 5050 m). The decrease in cerebral oxygen saturation was more pronounced at higher altitudes than in the periphery (rSO2/SaO2 = 0.56 at 5050 m). At higher altitudes (> 4450 m), two subjects showed reversible symptoms of AMS. The present data indicates that acute reduction in rSO2 values might be a primary cause of AMS, however, further studies and analysis are necessary to correlate our findings with cerebral symptom scores.     

Cerebral Regional Oxygen Saturation and Serum Neuromarkers for the Prediction of Adverse Neurologic Outcome in Pediatric Cardiac Surgery

Background

The aim of this study is to determine the utility of non-invasive bedside neuromonitoring, including cerebral regional oxygen saturation (rSO2) measured by near-infrared spectroscopy and serum biomarkers, in identifying children at risk from adverse neurological outcome after heart surgery.

Methods

Prospective observational study including 39 consecutive children undergoing heart surgery with cardiopulmonary bypass (CPB) and normal neurologic exam prior to surgery. Cerebral rSO2 was measured at baseline (prior to surgery) and then continuously during surgery and for the first 16 h post-operatively. Neuromarkers [neuron-specific enolase (NSE), S100β, glial fibrillary acidic protein (GFAP), and brain-derived neurotrophic factor (BDNF)] were measured in serum at baseline, immediately after CPB and at 16 h post-operatively. Adverse neurological outcome was defined as an abnormal pediatric cerebral performance category (PCPC) scale score at 12 months after surgery.

Results

Sixteen children (41 %) had an abnormal PCPC scale score at the 12-month evaluation after surgery. In children with unfavorable neurological outcomes, mean cerebral rSO2 values were lower and the area-under-the-curve below a threshold of 40 and 20 % below baseline were also increased. No significant differences were found in serum neuromarkers between groups at the time points that were assessed.

Conclusions

Bedside determination of cerebral rSO2 may have some utility in identifying children at risk for adverse neurological outcome after heart surgery in children. Additional studies that are sufficiently powered to control for the many covariates in this patient population will be required to fully interrogate this important question. The role of serum neuromarkers in the immediate post-operative period do not appear to be helpful in this question, though more thorough interrogation of delayed periods may ultimately demonstrate some utility in answering this question.     

Can urinary excretion rate of 8-isoprostrane and malonaldehyde predict postoperative cognitive dysfunction in aging?

Oxidative stress has been associated with mild cognitive impairment (MCI) and Alzheimer’s disease (AD). However, little is known about oxidative stress in postoperative cognitive dysfunction (POCD) in aging. The aim of this study was to investigate urinary excretion rate of 8-isoprostane:creatinine (U8-isoPG:Cr) and malonaldehyde:creatinine (UMDA:Cr) to predict short-term POCD in elderly patients undergoing general and orthopedic surgery. 72 patients aged above 65 years were enrolled in this prospective observational study. Each patient underwent cognitive testing to determine POCD performed by an investigator before surgery and 1 week after surgery. Morning urine was collected at baseline, 1, 2, and 7 days postoperatively. U8-isoPG was performed using enzymelinked immunosorbent assay (ELISA), and UMDA levels were measured by chemiluminescence detection. Creatinine levels were also analyzed if differences in the oxidative biomarkers were observed in the urine creatinine concentration. (1). Of 72 patients who completed cognitive testing, postoperative cognitive dysfunction was detected in 29.2 % (n = 21) of patients in 7 days. (2) U8-isoPG:Cr levels in 7 days postoperatively were significantly higher in POCD patients compared with the non-POCD group (p = 0.01). When measuring change from baseline, U8-isoPG:Cr levels were higher than that of control groups (p = 0.01). (3) UMDA:Cr levels were significantly elevated in 1 and 2 days postoperatively in both groups (p < 0.05). U8-isoPG:Cr level seems to be a valuable marker to detect lipid peroxidation early in POCD patients. However, it will also be important to take into account or reduce potential confounders to improve the identification of changes in the status of oxidative stress as a marker for POCD.     

麻醉诱导方式对颅内肿瘤手术病人脑血流动力学及颅内压的影响

目的 探讨异丙酚和咪唑安定诱导麻醉对颅内肿瘤手术病人脑血流动力学及颅内压（ICP）的影响。方法 2016年1月至2019年1月开颅手术治疗颅内肿瘤100例，其中50例（对照组）诱导麻醉采用静脉注射咪唑安定（0.2 mg/kg）+舒芬太尼（0.3 μg/kg）+顺苯磺酸阿曲库铵（0.2 mg/kg），50例（观察组）诱导麻醉采用静脉注射异丙酚（2 mg/kg）+舒芬太尼（0.3 μg/kg）+顺苯磺酸阿曲库铵（0.2 mg/kg）。①麻醉诱导前、诱导后即刻、插管前、插管后2 min、插管后6 min及插管后10 min监测心率（HR）、收缩压（SBP）、舒张压（DBP）及ICP。②插管后5 min、切开硬膜、切除肿瘤后30 min、手术结束时及拔管时监测颈内静脉血氧饱和度（SjvO2）及脑动静脉血氧分压差（Da-jvO2）。结果 ①插管后6 min、插管后10 min，两组HR均明显降低（P<0.05）；插管前两组SBP、DBP均明显降低（P<0.05）。插管后2 min，观察组SBP明显低于对照组（P<0.05）。两组ICP均无明显变化（P>0.05）。②观察组切开硬膜、切除肿瘤后30 min、手术结束时SjvO2水平较插管后5 min明显增高（P<0.05），而且观察组明显高于对照组。观察组切开硬膜、切除肿瘤后30 min、手术结束时Da-jvO2水平较插管后5 min明显降低（P<0.05），而且观察组明显低于对照组（P<0.05）。结论 异丙酚与咪唑安定均对颅内肿瘤手术病人ICP无明显影响；但是可改善脑血流动力学，而且咪唑安定对SjvO2和Da-jvO2水平的改善明显优于异丙酚     

右美托咪啶联用对老年缺血性脑血管病的作用对照研究

目的探讨联合应用右美托咪啶对老年缺血性脑血管病患者全麻术后认知功能的影响。方法选择2013-06—2016-06行全麻手术的老年缺血性脑血管病患者80例,根据随机数字表法分为异氟烷组(A组)、异氟烷+右美托咪啶组(B组)、七氟烷组(C组)、七氟烷+右美托咪啶组(D组),每组20例。麻醉前B组与D组静脉泵注右美托咪啶,A组与C组则以等量9g/L盐水替代右美托咪啶以相同方法静脉泵注。麻醉维持时A组与B组吸入异氟烷,C组与D组吸入七氟烷。观察术后认知功能,测定MMSE评分;并记录各组术前(T0)、插管后(T1)、手术关腹前(T2)、术后(T3)的HR、SBP、DBP、MAP、PetCO_2、SpO_2的变化。结果各组术后MMSE评分比较,4组术后1d、3d各组MMSE评分均较同组术前1d明显降低,差异均有统计学意义(P均0.05)。术后1d、3dB组较A组评分高,C组较D组评分高,差异均有统计学意义(P均0.05)。各组不同时间点生命体征指标比较,4组在插管后HR降低,与术前比较,B、D组HR值在插管后、关腹前、术后均明显下降(P均0.05);A、C组分别与B、D组比较,HR值在插管后、关腹前、术后均明显升高(P均0.05)。4组在插管后SBP、DBP均明显降低,直到手术后慢慢上升,术后A、C组明显升高,高于B、D组(P均0.05)。结论联合应用右美托咪啶,可减少麻醉性镇痛镇静药的用量,降低POCD的发生率,且有保护脑细胞的作用,可改善老年缺血性脑血管病患者术后的早期认知功能。