二异丙酚和七氟烷对老年患者术后认知功能恢复的影响

Effects of Disoprofol and Sevoflurane on the early recovery of postoperative cognitive function in elderly patients

目的：比较二异丙酚和七氟烷对老年患者术后认知功能恢复的影响。方法：选择美国麻醉医师协会（ASA）分级标准Ⅰ-Ⅱ的患者60例行择期上腹部手术，年龄≥65岁，随机分为二异丙酚组和七氟烷组，每组30例。全身麻醉诱导后维持麻醉分别用10-20μg/（kg·min）二异丙酚（二异丙酚组）和1%-3%七氟烷（七氟烷组），麻醉深度维持双频脑电指数（BIS）值在45-55之间，血压、心率控制在基础值的±20%内。记录手术后睁眼、拔管和语言应答时间等麻醉恢复指标，并于麻醉前、术后1、3、6和24 h采用简易智力状态检查表（MMSE）评价认知功能。结果：两组患者年龄、性别、体质量、手术时间、麻醉时间和麻醉药用量（除二异丙酚和七氟烷外）均无显著差异（P〉0.05）；二异丙酚组患者术后苏醒时间、拔管时间和拔管后语言应答时间均早于七氟烷组（P〈0.05）；两组患者术前MMSE评分无差异，二异丙酚组术后1和3 h评分较术前均明显下降（P〈0.05），七氟烷组患者术后1、3和6 h MMSE评分较术前均明显下降（P〈0.05）；七氟烷组较二异丙酚组评分低（P〈0.05）；二异丙酚组患者MMSE评分术后6 h恢复至术前水平，而七氟烷组术后24 h恢复至术前水平。结论：二异丙酚和七氟烷均可引起老年患者术后早期短暂的认知功能下降，但二异丙酚组较七氟烷组苏醒快，认知功能恢复早。

Objective： To investigate the effects of disoprofol and sevoflurane on the early recovery of postoperative cognitive function in elderly patients. Methods ： Sixty ASA Ⅰ - Ⅱ patients （ age ≥ 65 years） undergoing upper abdominal surgery were randomly assigned to a disoprofol group （ n = 30） and a sevoflurane group （ n = 30 ）. Following induction of anesthesia, disoprofol 10 - 20 μg/（ kg · min） （disoprofol group） or sevoflurane 1% -3% （ sevoflurane group） were administered to maintain BIS values between 45 and 55. The mean arterial blood pressure and heart rate were kept within 20% of the baseline values during the operation. The time for eye opening, extubation and verbalization after the operation were recorded in the recovery period. The mini-mental state examination （MMSE） was used to assess the cognitive function before and 1, 3, 6 and 24 h after the operation. Results： No significant differences were found between the two groups in age, sex, body weight, and the time of anesthesia or surgery. The times of eye opening , extubation and verbalization were markedly shorter in group D （ P 〈 0.05 ）. MMSE scores were significantly reduced at 1 and 3 h in the disoprofol group and at 1, 3 and 6 h in the sevoflurane group after the operation as compared with the preoperative values, with statistic difference between the two groups. And MMSE scores returned to the preoperative level 6 h after the operation in the disoprofol group and 24 h in the sevoflurane. Conclusion： Both disoprofol and sevoflurane can decline early postoperative cognitive function in elderly patients, but the former may effect an earlier awakening and faster recovery of cognitive function than the latter.