麻醉深度与病人早期术后认知功能障碍发生之间是否有关联，一直存在争议。中南大学湘雅医院麻醉科主任郭曲练领衔的研究团队，通过两年多的临床对比研究发现，适宜的麻醉深度可明显减少病人早期术后认知功能障碍的发生。
这意味着，医生通过合理调整手术期间可控麻醉相关因素，可降低病人术后脑功能障碍的发病率。该研究成果在美国权威医学期刊《神经外科麻醉期刊》上发表，引起广泛关注。
据专家介绍，麻醉学的发展经历了从单纯为手术提供镇痛、提高麻醉安全、提供舒适医疗到改善病人预后等四个阶段。由于近20年来麻醉并发症及死亡率已大大降低，麻醉对术后脑功能的影响逐渐引起重视。近年来的研究发现：麻醉过深可能威胁到病人的生命；而麻醉过浅则会影响手术操作，甚至发生患者术中知晓，造成长期精神创伤。
郭曲练带领湘雅医院麻醉科课题组采用全凭静脉麻醉，将96名面神经手术患者随机分为两组：较浅麻醉组46人，较深麻醉组50人。课题组对患者在术前及术后5天进行了包括9种项目的神经心理学测试。结果显示，麻醉较浅组有11例出现早期术后认知功能障碍，麻醉较深组仅为4例。进一步研究表明，较深麻醉组患者手术后早期认知功能障碍事件的发生明显减少，但其影响机制以及长时期认知功能障碍的发生机理，仍待进一步研究明确。
郭曲练表示：“该研究的价值在于它提示了一个重要信息：麻醉医生可通过调节围术期可控麻醉相关因素来改善患者的脑预后，为进一步探索麻醉与脑预后改善提供了新思路。”（生物谷 Bioon.com）
生物谷推荐原文出处：
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.
