瑞芬太尼与芬太尼对老年患者术后认知功能的影响

Influence of remifentanil and fentanyl on cognition function in geriatric surgical patients

目的比较瑞芬太尼和芬太尼全凭静脉麻醉对老年患者术后认知功能的影响。方法选择ASAⅠ或Ⅱ级,年龄65～70岁之间择期行腹腔镜下胆囊切除术患者80例,随机分为两组:瑞芬太尼加丙泊酚靶控输注组(R组,40例);芬太尼加丙泊酚靶控输注组(F组,40例)。所有患者于手术前1d及术后1、3、5d于每天16～18时进行成人韦氏量表评分(WAIS)。结果术后睁眼时间、拔管时间、复苏室停留时间R组明显短于F组(P<0.05)。拔管后Steward苏醒评分和Prince-Henry疼痛评分R组明显高于F组(P<0.05)。术后1d两组WAIS评分明显低于术前1d(P<0.05),术后5d两组WAIS评分明显高于术后1d(P<0.05)。两组间各时点WAIS评分比较差异无统计学意义。术中阿托品、麻黄碱、乌拉地尔用量组间差异无统计学意义。结论瑞芬太尼和芬太尼全凭静脉麻醉用于老年患者腹腔镜手术均可引起术后一过性认知功能减低,短期内认知功能会逐渐恢复到术前水平。

Objective To compare the effect of remifentanil and fentanyl on postoperative cognitive function in geriatric surgical patients. Methods Eighty ASA I or II geriatric patients, aged 65-70 years, undergoing laparoscopic operations were randomized into two groups： group R （propofol＋remifentanil anesthesia） and group F （propofol＋fentanyl anesthesia）. Cognitive function was assessed by the wechsler intelligence scale for adut （WAIS） in 16-18 hours at four time points： baseline and 1 day, 3 days, 5 days after surgery. Results The time to open eyes, extubation time and PACU stay were shorter in group R than in group F（P〈0. 05）. The scores of Steward and Prince Henry were higher in group R than in group F（P〈0. 05）. The WAIS scores in both groups decreased significantly at 1 day and increased at 5 day after operation but without difference between the two groups when compared with baseline（P〈0. 05）. There was no difference in the amounts of atropine, ephedrine and urapidil usages between two groups. Conclusion Target controlled infusion anesthesia with remifentanil and fentanil may induce temporarily postoperative cognitive dysfunction in geriatric surgical patients.