磷酸肌酸钠对颅脑手术患者术后早期认知功能障碍影响.docVIP

磷酸肌酸钠对颅脑手术患者术后早期认知功能障碍影响 　　【摘要】 目的 观察麻醉诱导前应用磷酸肌酸钠对颅脑手术患者术后早期认知功能的影响。方法 选择全麻下行择期颅脑手术患者50例，随机分为磷酸肌酸钠组和对照组,每组25例。磷酸肌酸钠组在麻醉诱导前10 min静脉注射磷酸肌酸钠1?0 g，对照组则给予等容积生理盐水，麻醉诱导后持续微泵注射瑞芬太尼及吸入七氟烷、泵注顺苯璜酸阿曲库铵维持麻醉和肌松。分别在术前1 d及术后48 h进行神经心理学评估并采用简易智力量表行认知功能测定,以及观察两组术后第1、2、3天血酸性钙结合蛋白 (S?100β)、神经元特异性烯醇化酶 (NSE)水平变化。结果 两组患者术前MMSE评分组间差异无统计学意义(P0?05)，磷酸肌酸钠组和对照组术后48 h MMSE评分≤23分的患者分别有2例(8％)和11例(44％)，两组术后认知功能障碍发生率差异有统计学意义(P 　　【关键词】 　　磷酸肌酸钠；颅脑手术；术后；认知障碍 　　Effects ofcreatine phosphate on cognitive dysfunction darly after neurosurgery in patients 　　XU Kang?qing，YANG Li?xuan，CHEN Mu?yao，et al. 　　Department of Anesthesiology, First Affiliated Hospital, SUN Yat?sen University, Guangzhou 510080, China 　　【Abstract】 Objective To observe the effects of Creatine Phosphate on cognitive dysfunction early after neurosurgeryinpatients under general anesthesia? Methods 50 patients scheduled for selective neurosurgery were randomly divided into two groups：Creatine Phosphate group(25 patients) and control group(25 patients)? The formmer were given 1?0 g of Creatine Phosphate introvenously 10 minutes before induction, and the latter were given the same?volume saline instead? Anesthesia was maintained with Remifentanil intravenous injection continually, Sevoflurane inhalation and supplemented with intravenous pump?injection of Cisatracurium? All patients were tested with a neuropsychological test, mini?mental state examination, preoperatively and 48 h postoperatively? The levels of serum S?100β, NSE were measured at 1,2,3 day after operation?Results No significant difference was found in height, weight, sex, and education level between two groups(P0?05)? There were no significant difference in the score of MMSE between Creatine Phosphate group and control group pre?operatively(P0?05)? The incidence of postoperative cognitive dysfunction in Creatine Phosphate group and control group was 8% and 44%, which was significantly different (P［1］。尽管目前其发生机制尚不清楚，但已有研究表明颅脑手术是引起POCD的高危因素［2］。麻醉药物的使用和手术的因素常导致术中低血压,低灌注产生脑细胞缺