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-  2018 

麻醉药物对非体外循环冠状动脉旁路移植术患者术后认知功能的影响 Effect of Different Anesthetics on Cognitive Function After Off-Pump Coronary Artery Bypass Grafting

Keywords: 谵妄,术后认知功能障碍,丙泊酚,咪唑安定,七氟醚

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Abstract:

目的:探讨不同麻醉药物对非体外循环冠脉搭桥(OPCABG)患者术后认知功能的影响。方法:按照预设标准选择择期拟行OPCABG的冠心病患者90例,随机分为3组,P组(丙泊酚组,n=30)1-2mg/kg丙泊酚静脉注射诱导麻醉并维持,M组(咪唑安定组,n=30)0.1-0.2mg/kg咪唑安定静脉注射诱导并维持麻醉,和S组(七氟醚组,n=30)2%-4%七氟醚持续吸入并维持。分别于术前1d和术后3d内对患者进行谵妄评估;于术前1天和术后7d对患者进行简易智能状态检查(MMSE)评分。结果:术前1d3组患者均未发生谵妄,术后所有患者镇痛效果均良好,所有患者均完成谵妄评估和MMSE评分。术后第3天P、M、S组分别有3(10%)、11(36.7%)、7(23.3%)例患者发生谵妄,3组间差异有统计学意义(P<0.05),但两两比较,仅P组与M组有统计学差异。术后第7天P、M、S组MMSE评分分别为26.9±1.06、25.6±1.24、26.4±1.33,3组间差异有统计学差异(P<0.05)。术后3组之间两两比较:P组与M组比较,P组术后MMSE评分更高,P<0.05,有统计学意义;S组与M组比较,S组术后MMSE评分更高,P<0.05,有统计学意义;P组与S组比较,P>0.05,无统计学差异。术后第7天P、M、S组分别有4(13.3%)、12(40%)、7(23.3%)例患者发生术后认知功能障碍(POCD),3组之间比较无统计学差异(P>0.05)。术后第7天3组之间POCD发生率两两比较:P组与M组比较,P组POCD发生率低于M组,P<0.05,有统计学意义;而P组与S组比较和M组与S组比较,P>0.05,无统计学差异。结论:在丙泊酚、咪唑安定、七氟醚3种麻醉镇静药物中,丙泊酚对非体外循环冠脉搭桥患者术后谵妄和认知功能的影响最小

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