全身麻醉的不同方法对老年患者术后认知功能障碍的影响

Effects of different methods of general anesthesia on postoperative cognitive dysfunction in the elderly patients

目的研究探讨不同麻醉方式对老年患者术后认知功能障碍的影响。方法以72例老年患者为研究对象,随机平均分为三组。A组术中给予瑞芬太尼、丙泊酚全凭静脉麻醉,B组给予七氟烷吸入麻醉,C组给予异氟烷吸入麻醉,术中根据患者的脑电双频指数监测值调整用药量,术后进行持续镇痛。记录三组患者的手术时间、麻醉时间、术后睁眼时间及拔管时间。比较三组患者手术前、后各时间点(1、3、6、24 h)的认知功能恢复情况。结果三组患者手术时间、麻醉时间对比差异无统计学意义(P>0.05)。B组和C组患者术后睁眼时间、拔管时间均明显长于A组(P<0.05)。三组患者术后1 h简易智力状态量表(MMSE)评分均明显低于术前(P<0.05),A组患者的MMSE评分于术后3 h恢复至术前水平,而B组为6 h,C组为24 h。结论在老年患者手术过程中给予全凭静脉麻醉和吸入麻醉,均能导致认知功能障碍,但全凭静脉麻醉恢复更快,吸入麻醉中七氟烷较异氟烷恢复更快。

Objective To explore the influence of different methods of anesthesia on postoperative cog- nitive dysfunction in the elderly patients. Methods In 72 cases of elderly patients as the research object, ran- domly divided into three groups. Group A was given remifentanil, propofol total intravenous anesthesia. Group B received sevoflurane inhalation anesthesia. Group C received isoflurane inhalation anesthesia. Patients were ad- justed the dosage of drugs according to the bispectral index value in operation, and received continuous analgesia after the operation. Record the operation time, anesthesia time, postoperative eye opening time and extubation time of three groups of patients. Compared the function of cognitive recovery of three groups before operation and the each time point （ 1, 3, 6, 24 h） after operation. Results The operation time and anesthesia time of three groups had no significant difference（ P 〉 0. 05 ）. The postoperative eye opening time and extubation time of group B and C were significantly longer than those of group A （ P 〈 0. 05 ）. In three groups the MMSE scores of postop- erative 1 h were significantly lower than preoperative （ P 〈 0. 05 ）. The MMSE scores of group A of postoperative 3 h returned to the preoperative level, while group B was 6 h, group C was 24 h. Conclusion The total intra- venous anesthesia and inhalation anesthesia in elderly patients all can cause cognitive dysfunction, but the total intravenous anesthesia can recover faster than inhalation anesthesia, and sevoflurane can recover faster than isoflurane in inhalation anesthesia.