七氟烷与丙泊酚对全子宫切除术患者认知功能的影响及麻醉效果比较

Comparison of the anesthesia effects of sevoflurane and propofol in extensive hysterectomy patients and the influence on cognitive function

目的 比较七氟烷与丙泊酚对广泛全子宫切除术患者认知功能的影响及麻醉效果.方法 选择行广泛全子宫切除术患者94例,依照抽签法分为对照组、观察组,每组47例,分别行丙泊酚和七氟烷麻醉,观察两组术后简易精神状态检查（MMSE）评分、认知功能障碍发生率及炎性因子、应激反应、血流动力学变化,比较两组麻醉效果和并发症发生情况.结果 术后,观察组MMSE评分高于对照组[（25.44±2.93）分比（23.96±3.18）分]（t=2.346,P=0.021）;观察组认知功能障碍发生率为2.12%,低于对照组的12.76%,两组差异有统计学意义（χ^2=3.858,P=0.049）.观察组炎性因子、应激反应及血流动力学指标均优于对照组（均P〈0.05）.观察组自主呼吸恢复时间、睁眼时间、拔管时间分别为（6.19±0.77）min、（6.89±0.86）min、（9.47±1.18）min,均短于对照组的（8.75±1.09）min、（9.36±1.17）min、（11.26±1.43）min,两组差异均有统计学意义（t=13.150、11.661、6.619,P=0.000,0.000,0.000）.两组并发症发生率差异无统计学意义（P〉0.05）.结论 七氟烷对广泛全子宫切除术患者认知功能的影响较丙泊酚小,且麻醉效果更确切.

Objective To compare the anesthesia effects of sevoflurane and propofol in extensive hysterectomy patients and the influence on cognitive function.Methods 94 patients of extensive hysterectomy were selected,according to the drawing method they were divided into control group and observation group,47 cases in each group,the patients were given propofol or sevoflurane anesthesia respectively.The postoperative mini-mental state examination（MMSE） score and the incidence of cognitive dysfunction,inflammation factors,stress reaction,hemodynamic,anesthetic effect and complications were observed in the two groups.Results After operation,the MMSE score of the observation group was higher than that of the control group[（25.44±3.18）points vs.（23.96±2.93）points]（t=2.346,P=0.021）,the incidence rate of cognitive dysfunction in the observation group was lower than that of the control group [2.12%（1/47） vs.12.76%（6/47）],there was satistically significant difference between the two groups（χ^2=3.858,P=0.049 5）.The inflammatory factors,stress reaction and hemodynamic index of the observation group were better than those of the control group（all P〈0.05）.The spontaneous breathing recovery time,open time,extubation time of the observation group were less than those of the control group [（6.19±0.77）min vs.（8.75±1.09）min,（6.89±0.86）min vs.（9.36±1.17）min,（9.47±1.18）min vs.（11.26±1.43）min],there were satistically significant differences between the two groups（t=13.150,11.661,6.619,P=0.000,0.000,0.000）.The complication rate had no difference between the two groups（P〉0.05）.Conclusion The effect of sevoflurane on cognitive function in patients with extensive hysterectomy is less than propofol,and the anesthesia effect is more precisely.