异氟烷与丙泊酚麻醉对心脏手术后患者认知功能的影响

Effects of Isoflurane Inhaled Anesthesia and Propofol Anesthesia on the Postoperative Cognitive Dysfunction of Patients Who Undergo CPB （cardiopulmonary bypass） Cardiac Surgery

【目的】研究异氟烷、丙泊酚两种麻醉方法对体外循环（CPB）心脏手术患者术后认知功能的影响。【方法】60例CPB心脏手术患者，年龄35～60岁，AsAⅡ～Ⅲ级，无严重肝肾功能受损和活动性炎症；随机分为丙泊酚全凭静脉麻醉组（P组）和异氟烷吸入麻醉组（I组），每组30例。两组均采用依托咪酯0．3mg／kg，舒芬太尼0．4～0．6μg／kg，咪达唑仑0．08～0．12mg／kg，维库溴铵0．1mg／kg完成麻醉诱导，气管内插管后行机械通气。I组以吸入异氟烷复合舒芬太尼、咪达唑仑、维库溴铵静注维持麻醉，吸入异氟烷呼气末浓度为1．5～2％。P组用丙泊酚4～6mg／kg／h持续泵入复合舒芬太尼、咪达唑仑、维库溴铵静注维持麻醉。术前1d，术后d，1个月用简易智力量表（MMsE）和数字广度对患者行神经心理学测试。【结果】①术后d，I组有9例发生了术后认知障碍（POCD），其POCD的发生率为30％，P组POCD发生率为26．7％（8／30）。术后1个月I组POCD的发生率为13．3％（4／30），P组POCD的发生率为10％（3／10）。P、I两组术后7d、术后1个月POCD发生率相比较差异无显著性（P〉0．05）；②两组术后MMSE和数字广度得分无统计学差别。③患者转流时间和受教育程度与POCD有关，与年龄无关。【结论】①丙泊酚静脉麻醉和异氟烷吸入麻醉对患者术后认知功能的影响没有统计学差别。②POCD与转流时间和受教育程度有关。

[Objective]To investigate the effects of isoflurane inhaled anesthesia and propofol anesthesia on the postoperative cognitive dysfunction of patients who undergo CPB （cardiopulmonary bypass） cardiac surgery. [Methods]60 patients of age 35-60 years old scheduled for CPB surgery, in state of ASAⅡ～Ⅲ, were randomly divided into two groups with 30 in group I （isoflurane group） and 30 in group P （propofol group）. There was an excluded standard： no serious hepatic and renal dysfunction and active inflammation. The two groups were induced by same method： etomidate 0.3 mg/kg, sulfentanyl 0.4 - 0.6μg/kg, Midazolam 0.08 - 0.12 mg/kg, vecuronium 0.1mg/kg, then had mechanical ventilation after tracheal intubation. Anesthesia was maintained by inhalation of isoflurane between 1.5 and 2 combined with intermittent injection of fentanyl, Midazolam and vecuronium in group I. Group P was maintained by propofol 4-6mg/kg/h, continuous infusion with intermittent injection of sulfentanyl, Midazolam, and vecuronium. The neuropsychology asμsessment was measured by MMSE（mini-mental state exam） and digit span the first day preoperative, after 7 days, and 1 month.[Results]9 patients showed cognitive dysfunction in group I and 8 in group P 7 day postoperative. The rate of POCD （postoperative cognitive dysfunction） in group I was 30% and 26.7% in group P. One month later after surgery, 4 patients still remained cognitive dysfunction in group I and 3 in group P. The rate of POCD in group I was 13.3% and 10% in group P; however, there was no statistic significance between the two groups （ P 〉0.05） o There was no statistic significance in MMSE and digit span score among the group I and group P postoperatively. The occurrence of POCD have positive relationship with CPB duration and education and with no relation- ship with age. [Conclusion]There is no statistic significance difference between Group I and group P on POCD in CPB surgery postoperatively. In addition, CPB duration and education has influence on POCD.