吴书宝 程伟

[摘要] 目的 观察丙泊酚复合七氟醚麻醉对全麻患儿脑指数及认知功能的影响。 方法 选择2018年1～12月江苏省徐州市新沂人民医院96例全麻疝气手术患儿，按术中麻醉方式分为单纯组（硬膜外丙泊酚麻醉）和复合组（硬膜外丙泊酚+喉罩七氟醚麻醉），每组各48例。比较两组患儿麻醉前1 min、麻醉后30 min脑指数，术前、术后3 d认知功能评分，术中、术后不良反应情况。 结果 与麻醉前1 min比较，单纯组患儿麻醉后30 min脑指数指标显著降低，且复合组显著低于单纯组，差异有统计学意义（P < 0.05）。与术前比较，单纯组患儿术后3 d蒙特利尔认知评估量表评分均显著下降，且复合组显著高于单纯组，差异有统计学意义（P < 0.05）。两组患儿不良反应率比较，差异无统计学意义（P > 0.05）。 结论 单纯硬膜外丙泊酚全身麻醉对小儿术后脑指数及认知功能有一定的影响，但丙泊酚复合七氟醚对小儿全身麻醉术后脑指数及认知功能的影响较小。

[关键词] 丙泊酚;七氟醚;认知功能;脑指数

[中图分类号] R719.8          [文献标识码] A          [文章编号] 1673-7210（2020）07（a）-0108-04

[Abstract] Objective To observe the effect of Propofol combined with Sevoflurane anesthesia on brain index and cognitive function in children under general anesthesia. Methods According to the difference of anesthesia methods during operation， a total of 96 children undergoing general anesthesia in Xinyi People′s Hospital， Jiangsu Province were divided into simple group （epidural Propofol anesthesia） and compound group （epidural Propofol + laryngeal mask Sevoflurane anesthesia） with 48 cases in each group. The brain index between the two groups 1 min before anesthesia and 30 min after anesthesia， cognitive function scores before and 3 days after surgery， and adverse reactions during and after surgery were compared. Results Compared with 1 min before anesthesia， the brain index of children in the simple group were significantly reduced 30 minutes after anesthesia， while the composite group were significantly lower than those in the simple group， and the differences were statistically significant （P < 0.05）. Compared with before surgery， the Montreal cognitive assessment scale scores of children in the simple group were significantly decreased on 3 days after surgery， while the composite group were significantly higher than those in the simple group， and the differences were statistically significant （P < 0.05）. There was no statistically significant difference in the adverse reaction rate between the two groups （P > 0.05）. Conclusion Simple epidural Propofol general anesthesia has a certain effect on the brain index and cognitive function in children after surgery， but Propofol combined with Sevoflurane has little effect on the brain index and cognitive function in children after general anesthesia.

[Key words] Propofol; Sevoflurane; Cognitive function; Brain index

臨床动物研究发现[1-2]，全麻药物对动物大脑发育有显著的影响。人和动物的大脑发育存在差异，如缺乏手术应激指标、生化代谢指标观察等[3]。因此，从当前研究现状而言，全麻药物对患儿大脑影响研究存在一定的局限性。鉴于此，本研究以江苏省徐州市新沂人民医院（以下简称“我院”）外科收治的全麻疝气手术患儿为研究对象，观察临床常见药物丙泊酚复合七氟醚对患儿全身麻醉术后脑指数及认知功能的影响，以期指导今后的临床工作。

综上所述，单纯硬膜外丙泊酚全身麻醉对患儿术后脑指数及认知功能有一定的影响，但丙泊酚复合七氟醚对患儿全身麻醉术后脑指数及认知功能基本无影响，这可能与同等麻醉平面下的丙泊酚复合七氟醚麻醉有效作用时间较短有关。……