异丙酚镇静对硬膜外麻醉老年人术后认知功能的影响

目的:以异丙酚镇静降低老年人硬膜外麻醉术中心理应激水平,观察其对术后认知功能的影响。方法:选择年龄65~80岁前列腺电切病人160例,ASAⅠ~Ⅱ级,文化程度为小学水平,随机分为两组:对照组,单纯行硬膜外麻醉;试验组,硬膜外麻醉联合异丙酚镇静,每组80人。试验组行异丙酚靶控镇静,以脑电双频指数(BIS)监测镇静深度,使BIS值维持在80左右。手术前1 d及手术后第5天进行8项神经心理测试评估认知功能;术中每5 min记录一次无创平均血压;手术结束后30 min进行术中舒适满意度评价。结果:试验组术中平均血压明显低于对照组,术中舒适满意度优于对照组(P<0.05)。试验组手术前后数字广度顺向测验和听觉词语学习成绩无明显变化,术后第5天听觉词语学习成绩好于对照组(P<0.05)。两组病人术后认知功能障碍(POCD)的发生率差别无统计学意义(P>0.05)。结论:硬膜外麻醉术中辅以异丙酚镇静降低术中不良心理应激,病人舒适满意度较高,可能具有一定程度降低老年人术后记忆能力损害的作用,但对减少POCD发生率的作用有限。

Effects of epidural anesthesia combined with propofol sedation on post-operative cognition in the elder

AIM: To investigate the effects of epidural anesthesia combined with propofol sedation on postoperative cognition in the elder.METHODS: 160 patients,aged 65-80 years with primary school educational level,scheduled for transurethral resection of the prostate(TURP),were randomly assigned into two groups(n=80 each group): control group and test group.Patients in control group received only epidural anesthesia.Patients in test group received epidural anesthesia combined with propofol sedation.Propofol was administered by target controlled infusion(TCI),the effect-site concentration was adjusted according to the number of bispectral index(BIS) by hand,maintain the number of BIS near 80.A battery of 8 neuropsychological tests were performed the day before surgery and the fifth day after surgery to evaluate cognition.The mean arterial pressure(MAP) was recorded every 5 min during operation.Patient comfort and satisfaction with the anesthesia was assessed 30 min after surgery.RESULTS: The MAP was lower,the score of patient comfort and satisfaction with the anesthesia was higher in test group compared with control group(P<0.05).The scores of Rey auditory verbal learning test and digit span forward changed no significantly between pre-and post-operation in test group(P>0.05).The score of Rey auditory verbal learning test in test group was better than that of control group 5 days postoperatively.There was no significant difference of incidence of postoperative cognitive dysfunction(POCD) between the two groups(P>0.05).CONCULSION: Using propofol sedation combined with epidural anesthesia to reduce psychological stress during operation,may reduce the postoperative memory impairment in some degree in the elder,and with a excellent patient comfort and satisfaction about anesthesia,but contribute to reduce the incidence of POCD is very limited.