不同麻醉方法对老年腹腔镜手术患者术后早期认知功能的影响

Effect of different anesthsia methos on early postoperation cognitive function in laproscope surgery of elderly patients

目的：比较异丙酚复合舒芬太尼全凭静脉麻醉与七氟醚全凭吸入麻醉对老年腹腔镜手术患者术后早期认知功能的影响。方法选择40例择期行腹腔镜直肠癌手术患者,年龄均大于60岁。ASA分级Ⅰ-Ⅱ级,随机分为异丙酚复合舒芬太尼全凭静脉麻醉组（A组）和七氟醚全凭吸入麻醉组（B组）,每组20例。两组患者分别于术前第1天、术后第1天、第2天、第5天采用简易智力状态检查表（MMSE）对两组患者进行认知功能评价。记录两组患者术中出血量、苏醒时间、拔管时间和术后恶心呕吐的发生率。结果两组术后第1天、第2天的MMSE评分与术前相比均降低,术后第1天、第2天A、B两组间的MMSE评分亦差异有统计学意义（P〈0.05）。术后第5天两组间MMSE评分差异无统计学意义。术后第1天认知功能障碍发生率A组15%, B组45%；术后第2天认知功能障碍发生率A组5%, B组30%。两组相比差异有统计学意义（P〈0.05）；术后第5天的认知功能障碍发生率A组0, B组5%,两组相比差异无统计学意义（P〉0.05）。结论异丙酚复合舒芬太尼全凭静脉麻醉较七氟醚全凭吸入麻醉对老年腹腔镜手术早期认知功能的影响小。

Objective To investigate the effects of different anesthsia methods on early postoperation cognitive function in laproscope surgery of elderly patients. Methods The sample included 40 patients between the ages of 60-75 who presented for laproscope surgery of rectal cancer. ASA I-II, they were randomly divided into two groups with different general anesthsia. In group A were total intravenous anesthsia with propoful combined with sufentanil. In group B were whole inhalation anesthsia with sevoflurane; Each group was twenty patients. Cognitive function was assessed on 1 d before operation and 1d, 3d, 5d after operation with MMSE. Then evalution the incidence and possible risk factors of Post Operation Cognitive Function（POCD）. Results Compared to 1 d before operation, the postoperative MMSE score were decreased in both groups. Group Bwas more significant （P〈0.05）. The first day after operation, 3（15%） patients occurred POCD in group A, 9（45%） in group B;The third day after operation, 1（5%） patients occurred POCD in group A, 6（30%） in group B;They all showed significant difference （P〈0.05）. Conclusion The method of total intravenous anesthsia with propoful combined with sufentanil occurs less POCD than whole inhalation anesthsia with sevoflurane in laproscope surgery of elderly patients.