异氟醚和七氟醚对老年患者术后认知功能的影响

Effects of isoflurane versus sevoflurane on postoperative cognitive function in old patients

目的观察异氟醚和七氟醚麻醉对老年患者术后12个月认知功能和血清β淀粉样蛋白(β-amyloid,Aβ)浓度的影响。方法选择全麻下行腹部手术患者77例,男43例,女34例,年龄65~75岁,ASAⅠ~Ⅲ级,采用随机数字表法分为两组:异氟醚组(I组,n=32)和七氟醚组(S组,n=45)。采用简易精神状态量表(mini-mental state examination,MMSE)于术前1 d、术后3 d和术后12个月进行认知功能评分。同时留取患者血清,于以上时点测定Aβ40和Aβ42浓度。结果术后3 d I组和S组的MMSE评分明显低于术前(P<0.05),且I组明显低于S组(P<0.05);术后12个月I组和S组POCD发生率差异无统计学意义[13例(40.6%)vs 15例(33.3%)]。两组不同时点血清Aβ42和Aβ40浓度差异无统计学意义。结论七氟醚对近期认知功能的影响小于异氟醚,但长期的影响可能是一致的;两者对患者术后12个月血清β淀粉样蛋白浓度无影响。

Objective To compare the effects of isoflurane compare sevoflurane on postoperative cognitive function and the level of serum β-amyloid in elder patients at 12 months after surgery. Methods Seventy-seven patients undergoing abdominal surgery, 43 males and 34 females, aged 65-75 years, ASA physical status I -m, were divided into two proups： isoflurane group （group I, n 232） and sevoflurane group （group S, n =45）. The patients＇ cognitive function were assessed u- sing mini-mental state examination （MMSE） 1 d before operation, 3 d and 12 months after opertion. Blood samples were taken before operation, 3 d and 12 monthes after operation for determination of serum Aβ42 and Aβ40 concentrations. Results The MMSE scores of the two groups 3 d after operation were significantly lower than those before operation （P〈0. 05）. The MMSE score 3 d after operation in group I was significantly lower than that in group S （P〈Q. 05）. The incidence of cognitive dys- function 12 months after operation had no significant difference between two groups [13 （40. 6%） ca- ses vs 15 （33, 3%） casesJ. There was no significant difference in the serum A1342 and A^40 concen- tration between groups. Conclusion Sevoflurane has less effect on postoperative cognitive function in short time than isoflurane, but its long-term effect seemed to be similar. The levels of Aβ42 and Aβ40 showed no difference between two groups.