地氟烷与七氟烷对老年全麻患者术后认知功能影响的比较

Comparison of the Effects of Desflurane and Sevoflurane on Postoperative Cognitive Function in Elderly Patients with General Anesthesia

目的:比较地氟烷与七氟烷对老年全麻患者术后认知功能的影响。方法:选择择期全身麻醉下开腹手术患者80例,美国麻醉医师学会(ASA)分级I^II级,采用随机数字表法分为地氟烷组和七氟烷组,每组40例。静脉注射咪达唑仑0.03 mg/kg、舒芬太尼0.5μg/kg,丙泊酚1~2 mg/kg、维库溴铵0.1 mg/kg诱导。2组术中分别以地氟烷或七氟烷维持麻醉,均将术中MAC值维持在1.2~1.4。分别记录患者术前,术后1 h、6 h、12 h、24 h、48 h的简易智力精神状态检测量表(Mini-Mental State Examination,MMSE)评分。结果:2组患者术前MMSE评分差异无统计学意义,2组患者术后1 h、6 h的MMSE评分均较术前显著下降(P<0.05),地氟烷组患者术后12 h MMSE评分基本恢复至术前水平。七氟烷组患者术后12 h MMSE评分均较术前显著下降(P<0.05),术后24 h基本恢复至术前水平。2组患者MMSE评分在术后1 h、6 h、12 h比较,地氟烷组患者MMSE评分高于七氟烷,差异有统计学意义。结论:老年患者采用地氟烷维持麻醉术后认知功能恢复较七氟烷维持麻醉明显加快。

Objective： To compare the effects of desflurane and sevoflurane on postoperative cognitive function in elderly patients with general anesthesia. Methods： A total of 80 cases of open surgery under general anesthesia were selected, were classed as ASA I-II, and were divided into desflurane group and sevoflurane group by random number table, 40 cases in each group. Midazoiam 0.03 mg/kg, sufentanil 0.5 μg/kg, propofol 1-2 mg/kg, vecuronium bromide 0.1 mg/kg were intravenousy injected to induce anesthesia. Anesthesia were maintained with intraoperatively desflurane or sevoflurane, and the intraoperative MAC value maintained at 1.2-1.4. The scores of Mini-Mental State Examination （MMSE） were recorded before operation and at 1 h, 6 h, 12 h, 24 h and 48 h after operation. Results： There was no significant difference in MMSE score between the two groups before operation （P〉0.05） . MMSE scores of the two groups at 1 h and 6 h after operation were significantly lower than those before operation （P〈0.05） . MMSE scores in desflurane group recovered to preoperative level at 12 h after operation, while MMSE scores of sevoflurane group was basically restored to preoperative level at 24 h after operation. MMSE scores in desflurane group at 1 h, 6 h and 12 h after operation were significant higher than those in sevoflurane group, the difference was statistically significant （P〈 0.05） . Conclusion： The recovery of cognitive function after anesthesia maintenance with desflurane in elderly patients is significantly faster than that of sevoflurane.