七氟烷复合瑞芬太尼或舒芬太尼对全麻患者术后早期认知功能的影响

Comparison between remifentanii-se voflurane and sufentanil-sevoflurane for general anesthesia on the early recovery of cognitive function in elderly patients

目的比较七氟烷复合瑞芬太尼或舒芬太尼对全麻患者术后早期认知功能恢复的影响。方法择期行上腹部手术患者60例，年龄60岁～75岁，体重49kg～80kg，美国麻醉医师协会（ASA）分级I～Ⅱ级，采用完全随机分组法分为瑞芬太尼七氟烷组（R组）和舒芬太尼七氟烷组（S组），每组30例。麻醉诱导以持续吸人3％～5％七氟烷，依次静注瑞芬太尼1．0μg／kg或舒芬太尼0．3μg／kg、罗库溴铵0．9mg／ks，脑电双频指数（bispectral index，BIS）值≤60维持5S后行气管插管。麻醉维持采用吸入七氟烷，小剂量输注瑞芬太尼或舒芬太尼维持平均动脉压mean artery pressure，MAP）在基础值20％的范围内。于麻醉前（T0）和拔管后1（T1）、3（T2）、6（L）、24h（T4）采用短期方向记忆注意力试验（the short orientation memory concentration test，SOMCT）和改良的瑞秋洛斯阿米哥斯量表rancho los amigos scale，aLAS）双盲法评估患者认知功能。结果两组SOMCT评分和RLAS评估基础值比较差异无统计学意义，Tl和T2时点R组SOMCT评分明显高于S组（P〈O．05）；RLAS评估Ⅷ级T1时点R组23例（77％）、s组8例（27％）（P〈O．05），T2时点R组28例（93％）、S组15例（50％）（P〈0．05），，r3时点R组30例（100％）、S组28例（93％）（P〉0．05）；T4时点两组患者认知功能均回到术前水平。结论上腹部手术七氟烷复合瑞芬太尼或舒芬太尼麻醉患者术后早期皆可出现短暂的认知功能下降，但R组术后早期认知功能恢复较快。

Objective To explore the effects of remifentanil-sevoflurane and sufentanil-sevoflurane for general anesthesia on the early recovery of cognitive function in elderly patients postoperative period. Methods Sixty ASA physical Status I - II patients （aged 60 y-75 y） were randomly assigned to one of two study groups： anesthesia with remifentanil-sevoflurane （R group） and sufentanil-sevoflurane （S group）. Induction of anesthesia was performed by administering sevoflurane constantly. Anaesthesia was induced either with remifentanil （ 1 μg/kg） or sufentanil （0.3 μg/kg） infusion, after loss of consciousness, rocuronium （0.9 mg/kg） was administered to facilitate endotracheal intubation. Remifentanil and sufentanil were subsequently titrated to lower doses according to the clinical need defined as the minimal dose required formaintaining MAP within 20% of baseline. Sevoflurane was administered at the discretion of the anaesthesiologist to keep the bispectral index （BIS） between 40 and 50. To evaluate cognitive function the Short Orientation Memory Concentration Test（SOMCT） and Rancho Los Amigos Scale（RLAS） were administered to all patients in a double-blind procedure before surgery and at 1, 3, 6 h and 24 h after extubation （ To, %, T2, T3, T4）. Results There was no significant differences in SOMCT scores and RLAS GradeⅧ at baseline in the two groups. SOMCT scores were significantly reduced in both groups at Tt and recovered to the preoperative level at T2 in R group , but at T3 in S group （P〈0.05）. RLAS GradeⅧ were significantly reduced in both groups, at T1 23 patients（77%） in R group and 8 patients （27%） in the S group （P〈0.05）, whereas at ＇T2 28 patients （93%） in R group and 15 patients （50%） in the S group（P〈0.05）. At T3 and T4 after extubation the RLAS Grade was ＇~;lar in the two groups. Conclusions These preliminary data show remifentanil- sevoflurane and sufentanil- sevoflurane can induce simi｜ar intraoperative haemodynamics and extubation time, though the early cognitive recovery is faster after use of remifentanil - sevoflurane than that of sufentanil- sevoflurane.