本文關(guān)鍵詞：氟馬西尼對(duì)七氟烷術(shù)后認(rèn)知功能的影響　出處：《南昌大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

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【摘要】：目的:觀察不同時(shí)間點(diǎn)MMSE評(píng)分以及術(shù)前術(shù)后血清皮質(zhì)醇濃度變化和蘇醒質(zhì)量對(duì)比，初步探討氟馬西尼對(duì)七氟烷術(shù)后認(rèn)知功能的影響及機(jī)制。 方法:選擇擬行腹腔鏡下子宮切除術(shù)患者60例為研究對(duì)象，年齡40-60歲，ASA I～I(xiàn)I級(jí),隨機(jī)分為實(shí)驗(yàn)組（F1組，，n=20）、靜脈組（F2組，n=20）、對(duì)照組（C組，n=20）三組，術(shù)前1天訪視病人，交待術(shù)前注意事項(xiàng)，取得病人和家屬的同意。無(wú)術(shù)前用藥，入手術(shù)室后，常規(guī)開(kāi)放上肢靜脈，接心電監(jiān)護(hù)，依病人情況以芬太尼3-5ug／kg、丙泊酚1.5-2.0mg／kg，維庫(kù)溴銨0.08-0.12mg／kg誘導(dǎo)， F1、C組術(shù)中吸入2-4%七氟烷維持+瑞芬太尼泵注，F(xiàn)1組術(shù)后靜注氟馬西尼0.5mg，C組術(shù)后使用等量生理鹽水，F(xiàn)2組術(shù)中用丙泊酚+瑞芬太尼維持，術(shù)后靜注氟馬西尼0.5mg。術(shù)中通過(guò)調(diào)節(jié)七氟烷吸入濃度和丙泊酚、瑞芬太尼泵注速度維持麻醉熵值在40-50。手術(shù)結(jié)束前30分鐘給予昂丹司瓊4mg靜注。開(kāi)始縫皮時(shí)停止七氟烷吸入和丙泊酚，接靜脈鎮(zhèn)痛泵，手術(shù)結(jié)束時(shí)停止瑞芬太尼泵注。當(dāng)呼氣末七氟烷濃度下降至0.45％～0.50％，或病人出現(xiàn)自主呼吸時(shí)給予實(shí)驗(yàn)藥物。三組患者均于術(shù)前（T0）、術(shù)后1h（T1）、12h（T2）、24h（T3）、48h（T4）分別由同一試驗(yàn)者采用簡(jiǎn)易精神狀態(tài)量表檢查（MMSE）對(duì)認(rèn)知功能進(jìn)行評(píng)價(jià)，并記錄三組麻醉停止后患者呼之睜眼、指令運(yùn)動(dòng)、定向力恢復(fù)時(shí)間，并在拔管即刻（S1）、拔管后10min（S2）、拔管后15min(S3)進(jìn)行Steward蘇醒評(píng)分。三組患者于麻醉前、拔管后采中心靜脈血3ml，使用ELISA方法進(jìn)行測(cè)定血漿皮質(zhì)醇濃度。統(tǒng)計(jì)學(xué)處理采用SPSS18.0軟件包完成。計(jì)量資料以均數(shù)（x）±標(biāo)準(zhǔn)差(s)表示，組內(nèi)比較采用配對(duì)t檢驗(yàn)，組間比較采用方差分析。以P＜0.05為差異有統(tǒng)計(jì)學(xué)意義，以P＜0.01為差異有顯著性。 結(jié)果: （1）三組病人在年齡、體重、受教育年限、麻醉時(shí)間等方面無(wú)明顯差異（P＞0.05）。 （2）術(shù)后蘇醒質(zhì)量的變化：三組患者睜眼時(shí)間無(wú)統(tǒng)計(jì)學(xué)意義；F1組和F2組定向力恢復(fù)時(shí)間較C組快，差異有統(tǒng)計(jì)學(xué)意義(P＜0.05)；F2組指令運(yùn)動(dòng)恢復(fù)時(shí)間較C組短，差異有統(tǒng)計(jì)學(xué)意義(P＜0.05)。 （3）Steward評(píng)分：三組內(nèi)Steward評(píng)分依次升高，C組在時(shí)間點(diǎn)S3的評(píng)分較S1明顯升高，差異有統(tǒng)計(jì)學(xué)意義(P＜0.05)；F1組和F2組在時(shí)間點(diǎn)S1、S2的Steward評(píng)分較C組高，差異有統(tǒng)計(jì)學(xué)意義(P＜0.05)；與F2組比較時(shí)，F(xiàn)1組各時(shí)間點(diǎn)的Steward評(píng)分均低，但差異無(wú)統(tǒng)計(jì)學(xué)意義（P＞0.05）。 （4）術(shù)后認(rèn)知功能的變化：三組患者術(shù)后MMSE評(píng)分顯示拔管后認(rèn)知功能較術(shù)前均有不同程度的降低，呈逐漸升高趨勢(shì)，三組依次在時(shí)間點(diǎn)T3、T2、T4恢復(fù)到術(shù)前水平；F1組和F2組在時(shí)間點(diǎn)T1、T2、T3認(rèn)知功能評(píng)分均較C組高，P＜0.05，差異有統(tǒng)計(jì)學(xué)意義；在T2時(shí)間點(diǎn)F1、F2兩組組間比較P＜0.05，差異具有統(tǒng)計(jì)學(xué)意義。 （5）血漿皮質(zhì)醇的變化：三組術(shù)后均比術(shù)前增高，F(xiàn)1和C組的變化有統(tǒng)計(jì)學(xué)意義(P＜0.05)；組間比較，F(xiàn)1組和F2組在術(shù)后血漿皮質(zhì)醇濃度較C組低，差異有統(tǒng)計(jì)學(xué)意義(P＜0.05)。 結(jié)論： 在本實(shí)驗(yàn)條件下，七氟烷會(huì)對(duì)患者的短期認(rèn)知功能產(chǎn)生可逆性損害，其恢復(fù)到正常認(rèn)知功能水平的時(shí)間較丙泊酚長(zhǎng)，靜注0.5mg氟馬西尼可在一定程度上改善七氟烷術(shù)后的蘇醒質(zhì)量，加快認(rèn)知功能的恢復(fù)。血漿皮質(zhì)醇的變化提示，氟馬西尼這種改善認(rèn)知功能的作用可能與減輕應(yīng)激反應(yīng)有關(guān)。
[Abstract]:Objective: To observe the MMSE score and the changes of serum cortisol concentration and recovery quality at different time points, and to preliminarily explore the effect and mechanism of Flumet on postoperative cognitive function after seven flurane.
Methods: undergoing laparoscopic hysterectomy in 60 patients as the research object, age 40-60 years old, ASA I ~ II, were randomly divided into experimental group (group F1, n=20), vein group (group F2, n=20), control group (group C, n=20) three groups, 1 day preoperative visit as a patient, explain precautions before operation, the patient and family's consent. No premedication into the operation room after conventional open vein of upper limb, with ECG monitoring, according to the patient's condition with fentanyl 3-5ug / kg, 1.5-2.0mg / kg 0.08-0.12mg propofol, vecuronium induced / kg, F1, C groups were inhaled 2-4% seven halothane maintain + remifentanil infusion, F1 group after intravenous injection of flumazenil using 0.5mg, normal saline C group after operation, maintenance operation in F2 group with propofol + remifentanil, postoperative intravenous injection of flumazenil in the 0.5mg. through the regulation of seven isoflurane and propofol remifentanil concentration, infusion rate to maintain anesthesia in entropy 40-50. operation Beam 30 minutes before giving ondansetron 4mg intravenous injection. Start skin closure of seven isoflurane inhalation and propofol, received intravenous analgesia pump, stop using remifentanil at the end of the operation. When the seven end tidal isoflurane concentration decreased to 0.45% ~ 0.50%, given the experimental drug or patient respiration. Three groups of patients in operation before (T0), 1h after operation (T1), 12h (T2), 24h (T3), 48h (T4) respectively by the same test using the mini mental state examination (MMSE) to evaluate the cognitive function, and record the three groups of patients after anesthesia stop called the open, instruction movement the recovery time of orientation, and immediately pull on the tube (S1), 10min after extubation (S2), 15min after extubation (S3) Steward awakening score. Three groups of patients before anesthesia, extubation after recovery of central venous blood 3ml, using the ELISA method for determination of plasma cortisol concentration. Statistical processing by SPSS18.0 the measurement data to software. Mean (x) + standard deviation (s). In group comparison, paired t test was used. Variance analysis was used between groups. The difference between P and < 0.05 was statistically significant, and the difference between P and < 0.01 was significant.
Result:
(1) there was no significant difference between the three groups in age, weight, years of education, and time of anesthesia (P > 0.05).
(2) the change of recovery quality after operation: there was no significant difference in eye opening time between the three groups. The recovery time of directional power in group F1 and group F2 was faster than that in group C (P < 0.05); the time of instruction recovery in group F2 was shorter than that in group C (P < 0.05).
(3) Steward score: three groups in Steward score were significantly increased, C group at the time point of S3 was significantly higher than that of the S1, the difference was statistically significant (P < 0.05); F1 group and F2 group at the time point of S1 S2, the Steward score was higher than that in group C, the difference was statistically significant (P < 0.05); compared with F2 group, F1 group at different time points of Steward score were low, but the difference was not statistically significant (P > 0.05).
(4) the change of cognitive function after surgery: three groups of patients with postoperative MMSE scores after extubation of cognitive function than before were reduced in different degree, the trend was gradually increased, the three groups were at the time point of T3, T2, T4 returned to the preoperative level; F1 group and F2 group at the time point of T1 T2, T3 cognitive function scores were higher than C group, P < 0.05, the difference was statistically significant; in T2 time point F1, F2 between the two groups P < 0.05, the difference was statistically significant.
(5) the change of plasma cortisol: the three groups were all higher than those before operation, and the changes in group F1 and C were statistically significant (P < 0.05). The plasma cortisol concentration in group F1 and F2 after operation was lower than that in C group, the difference was statistically significant (P < 0.05).
Conclusion:
In this experiment, seven halothane will produce reversible damage to short-term cognitive function of patients, restore to normal levels of cognitive function than propofol long time, intravenous injection of 0.5mg fluorine Marie Nicole is improved to a certain extent after seven halothane recovery quality, accelerate the recovery of cognitive function. The results suggest that changes of plasma cortisol this, flumazenil to improve cognitive function may be related to relieve stress.

【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R614

【參考文獻(xiàn)】

相關(guān)期刊論文 前5條

1 吳鋼;李惠萍;裴世成;陳麗;馮藝萍;陳君;戴體俊;;苯二氮怡受體與吸入麻醉藥鎮(zhèn)痛、催眠作用的關(guān)系[J];解放軍醫(yī)學(xué)雜志;2010年02期

2 胡憲文;劉健;管忍;李偉彥;;二異丙酚和七氟烷對(duì)老年患者術(shù)后認(rèn)知功能恢復(fù)的影響[J];醫(yī)學(xué)研究生學(xué)報(bào);2008年01期

3 胥琨琳,安剛,吳宏亮,劉建華,程永偉,張雁鳴;氟馬西尼對(duì)異氟醚麻醉后清醒恢復(fù)的影響[J];臨床麻醉學(xué)雜志;2003年07期

4 蔡一榕;薛張綱;朱彪;;患者術(shù)后認(rèn)知功能障礙的危險(xiǎn)因素分析[J];臨床麻醉學(xué)雜志;2006年08期

5 戴體俊,葉妙,傅英;注射揮發(fā)性麻醉藥對(duì)動(dòng)物的效應(yīng)[J];臨床麻醉學(xué)雜志;1997年05期

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