静脉麻醉与吸入麻醉对老年患者术后认知功能影响的比较

Comparison of the effect of intravenous anesthesia and inhalation anes-thesia on the postoperative cognitive functions of elderly patients

目的比较静脉麻醉与吸入麻醉对老年患者术后认知功能的影响。方法选择2015年6月~2016年7月于我院接受手术治疗的老年患者120例,按术中维持麻醉方法的不同将其分为静脉麻醉组(60例)与吸入麻醉组(60例),静脉麻醉组予丙泊酚+瑞芬太尼静脉泵注,吸入麻醉组予七氟烷+50%NO吸入。比较两组的手术时间、术中出血量、输液量及低血压、术后恶心、呕吐发生率及睁眼时间、拔管时间、应答时间;比较两组麻醉前、应答后1 h、应答后3 h、应答后12 h、应答后24 h简易智力状态量表(MMSE)得分以及术后认知功能障碍(POCD)的发生率。结果两组患者的手术时间、术中出血量、输液量及低血压、术后恶心、呕吐发生率比较,差异均无统计学意义(P>0.05);静脉麻醉组睁眼时间、拔管时间、应答时间均短于吸入麻醉组,差异有统计学意义(P<0.01);两组麻醉前MMSE得分比较,差异无统计学意义(P>0.05),应答后1、3、12 h静脉麻醉组MMSE得分均高于吸入麻醉组,差异有统计学意义(P<0.01);应答后24 h,两组MMSE得分比较,差异无统计学意义(P>0.05);静脉麻醉组POCD发生率为18.3%,吸入麻醉组为23.3%,两组比较,差异无统计学意义(P>0.05)。结论静脉麻醉与吸入麻醉均可能对老年患者术后认知功能产生一定的影响,但前者的影响时间相对短暂,术后恢复更快。

Objective To compare the effect of intravenous anesthesia and inhalation anesthesia on the postoperative cognitive functions of elderly patients.Methods 120 cases of elderly patients received surgery from June 2015 to July2016 in our hospital were selected and divided into the intravenous anesthesia group（60 cases） and inhalation anesthesia group（60 cases） according to the method of keeping anesthesia during operation.Patients in intravenous anesthesia group were given Propofol ＋Remifentanil intravenous infusion,while patients in inhalation anesthesia group were given inhalation of Sevoflurane＋50%NO.The operative time,amount of bleeding,transfusion volume,the incidence of hypotension,nausea,vomiting during operation,the time of eyes open,tube drawing and response were compared between the two groups;the MMSE score before anesthesia and 1,3,12,24 h after response and the incidence of POCD of two groups were compared.Results There was no statistically significant difference in operation time,amount of bleeding,transfusion volume and the incidence of hypotension,nausea and vomiting during operation between the two groups（P〈0.05）.The time of eyes open,tube drawing and response in the intravenous anesthesia group was shorter than that of the inhalation anesthesia group,and the difference was statistically significant（P〈0.01）.There was no statistically significant difference in MMSE score before anesthesia between the two groups（P〈0.05）.After answering,the MMSE scores of 1,3 and 12 h in intravenous anesthesia group were higher than those of inhalation anesthesia group,and the differences were statistically significant（P〈0.01）.But there was no statistically significant difference between the MMSE sores of 24 h in two groups（P〈0.05）;the incidence of POCD was 18.3% in the intravenous anesthesia group,that in the inhalation anesthesia group was 23.3%,and there was no statistically significant difference between the two groups（P〈0.05）.Conclusion Intravenous anesthesia and inhalation anesthesia may have some influence on postoperative cognitive function in elderly patients,but the former has a relatively shorter time and faster postoperative recovery.