七氟醚不同麻醉深度对老年泌尿手术术后认知功能的影响

Effects of Sevoflurane in Different Depth of Anesthesia on the Cognitive Function of Elderly Patients with Urological Surgery

目的：探讨七氟醚在不同麻醉深度下对老年泌尿手术患者术后认知功能的影响。方法选择2014年6月至2015年7月间在本院接受泌尿手术治疗的老年患者80例作为研究对象，按照随机数表法分为接受高浓度七氟醚麻醉（ BIS值35~45）的观察组、接受低浓度七氟醚麻醉的（BIS值50~60）对照组，每组各40例。分别记录两组手术时间、手术出血量、术中输液量、低血压次数、瑞芬太尼注射液剂量和呼气末七氟醚浓度，同时采用简易精神状况检查量表（ MMSE）评估两组患者手术前1d及术后1、3、7d的认知功能。结果两组手术时间、麻醉时间、手术出血量、术中输液量、低血压发生次数、瑞芬太尼注射液剂量比较差异无统计学意义（P〉0.05）。呼气末七氟醚浓度有统计意义（P〈0.05），两组术后1、3、7 d的MMSE评分均明显低于手术前（P〈0.05），而且术后1、3 d的MMSE评分对照组较观察组降低更加明显（P〈0.05）；对照组术后1、3 d的pOCD发生率均明显高于观察组，差异具有统计学意义（P〈0.05），而两组术后7 d的pOCD发生率差异无统计学意义（P〉0.05）。结论七氟醚在深麻醉下有助于减少对老年泌尿手术患者术后认知功能的影响。

Objective To investigate the effects of Sevoflurane in Different Depth of Anesthesia？ on the Cognitive Function of Elderly patients with Urological Surgery. Methods 80 elderly patients with urological surgery from June, 2014 to July, 2015 were selected. The patients were divided into observation？ group （40 cases） and control group （40 cases） according to random number ta-ble. The patients in observation group received high concentrations of sevoflurane （BIS value was 35~45）, while low concentrations of sevoflurane （BIS value was 50~60） in control group. Data were collected during the operations, amount of bleeding, intraopera-tive transfusion volume, number of low blood pressure, dose of remifentanil injection and end-expiratory sevoflurane concentration. Meanwhile, the mini mental state examination scale （ MMSE） was used to evaluate the cognitive function of preoperative 1 d as well as postoperative 1, 3 d and 7 d between the two groups. Results The differences in operation time, anesthesia time, amount of bleed-ing, intraoperative transfusion volume, number of low blood pressure, dose of remifentanil injection between the two groups were not statistically significant （P〉0. 05）. The difference in end-expiratory sevoflurane concentration between the two groups was statistically significant （P〈0. 05）. The scores of MMSE in postoperative 1, 3 d and 7 d of patients in the two groups were significantly lower than that before operation （P〈0. 05）. The incidence rate of pOCD in postoperative 1 d, 3 d in control group was significantly higher than that in observation group （P〈0. 05）, and the difference was statistically significant. The difference in the incidence rate of pOCD in postoperative 7 d between the two groups was not statistically significant （P〉0. 05）. Conclusions Sevoflurane is helpful to reduce the impact on postoperative cognitive dysfunction in elderly patients with urinary surgery in deep anesthesia.