不同麻醉药物对中老年患者麻醉效果及术后认知功能障碍的影响

Comparative Analysis of Anesthetic Effect and Postoperative Cognitive Dysfunction of Different Anesthetic Drugs in Middle-aged and Elderly Patients

【目的】比较不同麻醉药物对中老年患者麻醉效果及术后认知功能障碍的影响。【方法】本院收治的94例行全麻手术的老年患者，根据入院顺序分为两组，每组47例。观察组采用依托咪酯＋瑞芬太尼麻醉，对照组为丙泊酚＋瑞芬太尼。观察比较两组患者麻醉及术前和术后d3认知功能情况。【结果】术后d。观察组的简易精神状态检查表（MMSE）评分显著高于对照组[（23．31±0．98）分比（21．05±1．02）分]（P〈0．05）。观察组的睫毛反射消失时间、意识消失时间、眼球固定时间显著长于对照组（P〈0．05）。麻醉诱导前两组患者的收缩压、舒张压、心率比较差异无显著性（P〉0．05）；插管后3min观察组患者的收缩压、舒张压、心率较麻醉诱导前显著降低P〈0．05），但明显高于对照组（P〈0．05）。【结论】老年患者在麻醉中使用丙泊酚进行麻醉，虽然起效较快，但对患者的认知功能及应激反应较依托咪酯影响较大，因此临床麻醉中应针对患者具体情况选取最佳麻醉方案。

[ObjectivelTo compare the anesthetic effect and postoperative cognitive dysfunction of different narcotic drugs in middle-aged and elderly patients. [MethodslA total of 94 elderly patients undergoing general anesthesia in our hospital were divided into two group according to the order of admission, with 47 cases in each group. In the observation group （Group A）, patients were received etomidate and remifentanil, and pa- tients in the control group （Group B） received propofol and remifentanil. The cognitive function of the two groups was recorded before and after operation and 3 days after operation. The operation intubation were ana- lyzed. [Results]The mini mental status checklist （MMSE） score of Group A on day 3 after surgery （23.31± 0.98） was significantly higher than that of Group B （21.05±51.02, P 〈0.05）. The disappearing time of eyelash reflex and consciousness as well as fixation time of eyeball in Group A were significantly longer than group B （ P 〈0.05）. Before induction of anesthesia, SBP（systolic blood pressure）, DBP （diastolic blood pressure） and HR （heart rate） of patients in the two groups showed no significant difference （ P 〉0.05）. 3min after intuba tion, the SBP, DBP and HR in Group A were significantly lower than those before the induction of anesthesia （ P 〈0.05）, and the decreasing value of Group A was significantly higher than that of Group B（ P 〈0.05）. [Conclusion]The use of propofol in elderly patients during anesthesia is effective. However, compared to the usage of etomidate, it has greater impact on cognitive function and patient＇s stress response. So the clinical an- esthesia should be selected according to the specific circumstances of the patient.