不同剂量氯胺酮静脉麻醉对乳腺区段切除术后早期认知功能的影响 #br#

目的 探讨不同剂量的氯胺酮辅助全凭静脉麻醉对乳腺区段切除患者术后早期认知功能及疼痛的影响。 方法 选择我院择期在全凭静脉麻醉下行乳腺区段切除术的患者 120例，随机分为 4组（n＝30），不使用氯胺酮的对 照组（A组）和氯胺酮剂量分别给予 0.5 mg/kg（B组）、1.0 mg/kg（C组）、1.5 mg/kg（D组）的观察组。记录 4组患者麻醉诱导前（t0）、喉罩置入后（t1）、切皮后 1 min（t2）和切皮后 25 min（t3）各时间节点的平均动脉压（MAP）、心率（HR）的变化数值。随访记录术后 2 h（T1）、6 h（T2）、12 h（T3）、24 h（T4）疼痛视觉模拟评分（VAS）。分别采用简易智能精神状态检查量表（MMSE）和蒙特利尔认知评估量表（MoCA）两种评分方法评估术前 1 d（T0），及术后 2 h（T1）、6 h（T2）、12 h（T3） 和 24 h（T4）的认知功能。结果 术中 MAP、HR组内比较，B组各时间点变化最小、最稳定（P＞0.05），A组各相邻时间 点差值变化最大（均 P＜0.05）。VAS 评分 B、C、D 组 T1～T3低于 A 组；B、C、D 组间比较差异均无统计学意义（P＞ 0.05）。MMSE、MoCA评分比较，4组在 T0和 T4时间点差异均无统计学意义（P＞0.05）；T1时间点 D组＜C组＜B组＜A 组（均 P＜0.05）；T2时 A组＞B组＞C组/D组（均 P＜0.05），T3时各组均较 T2时评分明显上升（均 P＜0.05）。结论 氯 胺酮可降低乳腺区段切除术后患者早期认知功能，且与剂量呈依赖性，但对术后 24 h的认知功能无影响，小剂量的 氯胺酮影响更小且术后镇痛效果好，术中生命体征更稳定。

Effects of different doses of ketamine intravenous anesthesia on the early#br# cognitive function after segmental mastectomy #br#

Objective To investigate the effects of different doses of ketamine-assisted total intravenous anesthesia on the early cognitive function and pain in patients undergoing segmental mastectomy. Methods A total of 120 patients undergoing elective segmental mastectomy under total intravenous anesthesia were selected and randomly divided into fourgroups (n=30), including the control group (groupA) without ketamine and the observation group given ketamine at 0.5 mg/kg(group B), 1.0 mg/kg (group C) and 1.5 mg/kg (group D), respectively. The changes in mean arterial pressure (MAP) and heartrate (HR) of the four groups of patients were observed and recorded before anesthesia induction (t0), after laryngeal mask placement (t1), 1 minute after skin incision (t2), and 25 minutes after skin incision (t3). The Visual Analogue Scale (VAS) wasclosely followed at 2 hours (T1), 6 hours (T2), 12 hours (T3) and 24 hours (T4) after surgery. The scoring methods of MiniMental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were used to evaluate the early postoperativecognitive dysfunction (POCD) 1 day (T0) before surgery, and 2 hours (T1), 6 hours (T2), 12 hours (T3) and 24 hours (T4) aftersurgery. Results The changes of MAP and HR in each time point during the operation were the smallest and stable in thegroup B (P＞0.05), and the different value of adjacent time point was the largest in group A (P＜0.05). The VAS scores of T1-T3 were lower in group B, C and D than those in group A (P＜0.05), and there was no significant difference between groupsB, C and D (P＞0.05). There were no significant differences in MMSE and MoCA scores at T0 and T4 time points between thefour groups (P＞0.05). T1 time point was significantly lower in group D＜group C＜group B ＜ group A (P＜0.05). T2 timepoint was group A ＞ group B ＞ group C and D (P＜0.05). The scores of T3 time points were significantly higher than those of T2 (P＜0.05). Conclusion Ketamine can reduce the early cognitive function in patients after segmental mastectomy withdose dependent manner, but no effect on the cognitive function 24 hours after operation. The low dose of ketamine has goodanalgesia effect and more stable vital signs during the operation.