麻醉深度與病人早期術(shù)后認(rèn)知功能障礙發(fā)生之間是否有關(guān)聯(lián),，一直存在爭(zhēng)議。中南大學(xué)湘雅醫(yī)院麻醉科主任郭曲練領(lǐng)銜的研究團(tuán)隊(duì),，通過兩年多的臨床對(duì)比研究發(fā)現(xiàn),，適宜的麻醉深度可明顯減少病人早期術(shù)后認(rèn)知功能障礙的發(fā)生,。
這意味著,，醫(yī)生通過合理調(diào)整手術(shù)期間可控麻醉相關(guān)因素，可降低病人術(shù)后腦功能障礙的發(fā)病率,。該研究成果在美國(guó)權(quán)威醫(yī)學(xué)期刊《神經(jīng)外科麻醉期刊》上發(fā)表,，引起廣泛關(guān)注。
據(jù)專家介紹,，麻醉學(xué)的發(fā)展經(jīng)歷了從單純?yōu)槭中g(shù)提供鎮(zhèn)痛,、提高麻醉安全、提供舒適醫(yī)療到改善病人預(yù)后等四個(gè)階段,。由于近20年來麻醉并發(fā)癥及死亡率已大大降低,，麻醉對(duì)術(shù)后腦功能的影響逐漸引起重視。近年來的研究發(fā)現(xiàn)：麻醉過深可能威脅到病人的生命,；而麻醉過淺則會(huì)影響手術(shù)操作,，甚至發(fā)生患者術(shù)中知曉，造成長(zhǎng)期精神創(chuàng)傷,。
郭曲練帶領(lǐng)湘雅醫(yī)院麻醉科課題組采用全憑靜脈麻醉,，將96名面神經(jīng)手術(shù)患者隨機(jī)分為兩組：較淺麻醉組46人，較深麻醉組50人,。課題組對(duì)患者在術(shù)前及術(shù)后5天進(jìn)行了包括9種項(xiàng)目的神經(jīng)心理學(xué)測(cè)試,。結(jié)果顯示，麻醉較淺組有11例出現(xiàn)早期術(shù)后認(rèn)知功能障礙,，麻醉較深組僅為4例,。進(jìn)一步研究表明，較深麻醉組患者手術(shù)后早期認(rèn)知功能障礙事件的發(fā)生明顯減少,，但其影響機(jī)制以及長(zhǎng)時(shí)期認(rèn)知功能障礙的發(fā)生機(jī)理,，仍待進(jìn)一步研究明確。
郭曲練表示：“該研究的價(jià)值在于它提示了一個(gè)重要信息：麻醉醫(yī)生可通過調(diào)節(jié)圍術(shù)期可控麻醉相關(guān)因素來改善患者的腦預(yù)后,，為進(jìn)一步探索麻醉與腦預(yù)后改善提供了新思路,。”（生物谷 Bioon.com）
生物谷推薦原文出處：
Journal of Neurosurgical Anesthesiology doi: 10.1097/ANA.0b013e3181f59db4
Deeper Total Intravenous Anesthesia Reduced the Incidence of Early Postoperative Cognitive Dysfunction After Microvascular Decompression for Facial Spasm
An, Jianxiong MD*; Fang, Qiwu MD?; Huang, Changsheng MD*; Qian, Xiaoyan MB?; Fan, Ting MD?; Lin, Yanjun MD?; Guo, Qulian MD*
Objective: To investigate whether the depth of total intravenous anesthesia affects postoperative cognitive dysfunction.
Methods: Ninety-six patients with facial spasm who were scheduled to receive microvascular decompression were randomly divided into 2 groups: deeper anesthesia (n=50) and lighter anesthesia (n=46). Exclusion criteria included: a history of neurologic or mental disease, serum creatinine in excess of 177 μmol/L, active liver disease, cardiac dysfunction, pulmonary dysfunction, endocrine disease, metabolic disease, a history of surgery, fewer than 6 years of school, inability to complete neuropsychologic testing, vision dysfunction, and auditory dysfunction. Propofol and sufentanil were used for anesthesia induction and propofol and remifentanil were used for the maintenance of anesthesia. A battery of 9 neuropsychologic was administered preoperatively and 5 days after surgery. A postoperative deficit was defined as a postop decrement to preop score greater than 1 standard deviation on any test. Patients who experienced 2 or more deficits were deemed to have early postoperative cognitive dysfunction.
Results: Eighty patients completed both preoperative and postoperative neuropsychologic testing, of which 40 each were in the deeper and lighter anesthesia group. Postoperative early cognitive dysfunction occurred in 4 patients (10%) in the deeper anesthesia group and in 11 patients (27.5%) in the lighter anesthesia group. The incidence of the postoperative cognitive dysfunction was significantly reduced in the deeper anesthesia group compared with the lighter anesthesia group (P<0.05, χ2).
Conclusion: Deeper total intravenous anesthesia can decrease the incidence of cognitive dysfunction in the early postoperative period.
