不同麻醉药物对老年患者术后认知功能障碍的影响

Influence of remifentanil,isoflurane and fentanyl for general anesthesia on the postoperative cognitive function in elderly patients

目的 比较瑞芬太尼、异氟醚和芬太尼对老年患者全身麻醉术后早期及术后1~12个月认知功能的影响。方法 选择美国麻醉师协会（ASA）Ⅰ~Ⅱ级非心脏手术老年患者90例作为研究对象,其中瑞芬太尼、异氟醚和芬太尼各30例。于麻醉前及术后1、3、6、24h采用简易智力状态检查（MMSE）测试评价认知功能,并于术后1、3、6、12个月,通过电话、信件及门诊复查等方式完成MMSE,以测试评价认知功能。结果 瑞芬太尼组睁眼时间、拔管时间及说话时间均早于其他两组患者,差异有统计学意义（P〈0.05）;术后1、3、6、24h的MMSE评分比较,瑞芬太尼组高于其他两组,差异有统计学意义（P〈0.05）;瑞芬太尼组术后1~12个月的认知功能障碍（POCD）发生率明显低于其他两组,差异有统计学意义（P〈0.05）。结论 瑞芬太尼、异氟醚及芬太尼均可引起老年患者POCD,但瑞芬太尼较异氟醚和芬太尼恢复更快。

Objective To compare the influence of remifentanil,isoflurane and fentanyl on the cognitive function in aged patients.Methods 90 ASA physical status I-II consenting elderly patients were assigned to three general anesthetic groups.The mini-mental state examination（MMSE）Was used to assess cognitive function preoperatively and 1,3,6,24 hand 1,3,6,12 month after operation.Results No significant differences were found between three groups in the general information（P0.05）;The time for eye opening,extubation,and verbalization were markedly shorter in group remifentanil.The MMSE of remifentanil in 1,3,6,24 hwere higher than other two groups.The incidence of POCD of the remifentanil group was significantly lower than the other two groups.Conclusion Both remifentanil,isoflurane and fentanil can result in POCD in elderly patients,though the recovery is faster after the use of remifentanil than that of isoflurane and fentanil.