不同诱导剂量咪达唑仑对肺癌手术患者术后认知功能的影响 *

2016-01-07王炯,何静,张先政

西部医学 2015年10期

不同诱导剂量咪达唑仑对肺癌手术患者术后认知功能的影响*

王炯何静张先政

(遂宁市中心医院麻醉科，四川遂宁 629000)

【摘要】目的研究不同诱导剂量咪达唑仑对肺癌手术患者术后认知功能的影响。方法将102例择期进行肺癌手术的患者按照咪达唑仑不同浓度G1(0.06mg/kg)、G2(0.08mg/kg)、G3(0.1mg/kg)、G4(0.12mg/kg)随机分为四组。患者施行全凭静脉全身麻醉。依次以咪达唑仑、枸橼酸芬太尼、丙泊酚脂肪乳注射液进行麻醉诱导，5min后进行气管插管，再行手术。记录患者心率、平均动脉压、血氧饱和度；分别于术前一天、术后第一天使用简易精神状态评定量表(MMSE)对患者认知功能进行评估，比较各组患者术后认知障碍发生情况。结果①随着用药剂量的增大，患者平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2)以及苏醒时脑电双频指数(BIS)无显著性差异，但睁眼时间逐渐缩短，丙泊酚用量也依次减少，发生躁动的患者比例也随之降低。②术后患者MMSE评分较术前均有一定程度降低，咪达唑仑诱导剂量越小，评分降低越多，χ`2=4.684，P<0.05，差异有统计学意义。③咪达唑仑诱导剂量越大，其认知障碍发生率越高，四组认知功能障碍(POCD)发生率依次为30.8%、23.1%、16.0%和16.0%，差异具有统计学意义(P<0.05)。结论咪达唑仑用量越大，术中麻醉用药剂量减少，术后POCD发生率也明显降低，但过高可能导致其他不良症状，以0.1 mg/kg较为适宜。

【关键词】咪达唑仑；诱导剂量；认知功能

【中图分类号】R 734.2

【文献标志码】A

doi：10.3969/j.issn.1672-3511.2015.10.027

Abstract【】ObjectiveTo study the effects of different amount of induction meterage midazolam on the lung cancer operation patients’ anesthesia effect and cognitive function. Method102 patients with lung cancer to take operation recently were divided into four groups including R1(0.06ng/ml), R2(0.08ng/ml), R3(0.1ng/ml) and R4(0.12ng/ml) according to different amount of induction meterage midazolam. Patients were given Fentanyl citrate, Propofol injection by inhalative anesthesia, and then take trachea cannula after five minutes, finally operation. HR, MAP, SpO2 during operation were observed. The cognitive function of patients before and after surgery was evaluated with the MMSE. The rate of POCD was observed. ResultsWith the increase of dose, there were no significant difference between MAP, HR, BIS after waking and SpO2 of patients, but the goggle time gradually shortened, and the dosage of propofol reduced. The proportion of patients with emergence agitation also reduced. Compared with the preoperative score, MMSE score after operation decreased to some extent. If the dosage of midazolam was smaller, the score decreased more,χ`2=4.684,P<0.05,with significant difference. If the midazolam were given more, the rate of POCD became greater. The rate of POCD in the four groups were relatively 30.8%,23.1%,16.0%,16.0%,w ith significant difference.ConclusionThe beg dosage of midazolam could lead a reduction of anesthesia dose used during operation. But too high may introduce other adverse symptoms, and 0.1mg/kg is more suitable.

基金项目：四川省卫生厅科研课题(110610)

收稿日期：( 2015-03-20；编辑：陈舟贵)

Effects of different amount of induction meterage midazolam on the lung cancer operation patients’ cognitive functionWANG Jiong，HE jing，ZHANG Xiangzhen

(DepartmentofAnesthesiology,SuiningCentralHospital,Suining629000,Sichuan,China)

【Key words】Midazolam; Induction dose; Cognitive function

1资料与方法

1.1一般资料本次实验的研究对象是102例择期进行肺癌手术的患者。男60例，女42例，平均年龄(53.8±16.9)岁。所有患者均无心、肝、肾脏器功能性疾病及精神系统疾患。将患者按咪达唑仑不同浓度G1(0.06mg/kg)、G2(0.08mg/kg)、G3(0.1mg/kg)、G4(0.12mg/kg)随机分为四组，各组患者的基本资料无显著性差异(P>0.05)，见表1。