关键词: 超前镇痛, 静吸复合麻醉 , 全凭静脉麻醉, 术后认知功能障碍

Abstract:

Objective To investigate the effects of preemptive analgesia on postoperative cognitive function in patients undergoing general anesthesia. Methods Forty patients who underwent abdominal surgery with the anesthetic duration longer than 3 hours were included in this study. The patients were attibuted to four groups:the total intravenous anesthesia group（TIVA group, n=10）, TIVA + preemptive analgesia group（TIVAPA group, n=10）, Combined intravenous and inhalative anesthesia （CIIA group, n=10）and CIIA + preemptive analgesia group（CIIAPA group, n = 10）. Cognitive function was assessed at three time points:1 d preoperation, 7 d and 30 d post-operation by several scoring systems including MMSE, TMT, BVMT, HVLT. The levels of serum C-reactive protein（CRP）and interleukin-6 （IL-6）were measured. The pain assessment in all patients were assessed by visual analogue scale（VAS） in 24 hours post-operation. The scores of cognitive function, CRP and IL-6 and VAS were compared between the four groups. Results MMSE, BVMT and HVLT scores decreased significantly in the three groups of patients treated with TIVA group, CIIA group and CIIAPA group （P<0.05）. The most significant decrease in MMSE and BVMT scores was CIIA group. The most significant decrease in HVLT-T score was CIIA group And CIIA PA group. At 7 days post-operation, the HVLT-R score of TIVA group was restored to the level of 1 day before operation. The HVLT-R score of CIIA group was improved by 1 day after operation but still lower than that before operation（P<0.05）. After 7 days of CIIA group and CIIAPA group, HVLT-T was still lower than that of preoperative day（P<0.05）. The VAS scores of TIVAPA group and CIIAPA group were significantly lower than those of TIVA group and CIIA group （P<0.05）. The levels of serum CRP and IL-6 in CIIA + PA group and TIVAPA group was significantly lower than that in TIVA and CIIA groups（P<0.05）. Conclusion The sevoflurane plays a leading role in the occurrence of POCD in the short time after operation. The effect of preemptive analgesia that used NSAIDs drugs Parecoxib sodium and local nerve block on the POCD is very limited.

Key words: total intravenous anesthesia, preemptive analgesia, combined intravenous and inhalative anesthesia, postoperative cognitive dysfunction