异丙酚与七氟醚麻醉对老年输尿管镜手术患者麻醉术后苏醒质量和认知功能影响的比较

Comparison of effects of propofol and sevoflurane anesthesia on postoperative awakening quality and cognitive function in elderly patients undergoing ureteroscopic surgery

目的探讨异丙酚与七氟醚麻醉对老年老年输尿管镜手术患者麻醉术后苏醒质量和认知功能影响的比较。方法选取2015年1月～2017年12月择期输尿管镜手术治疗的老年患者80例,分为异丙酚组和七氟醚组各40例,分别采用异丙酚静脉麻醉和七氟醚吸入麻醉。观察两组患者麻醉术后苏醒质量指标,并评估麻醉前(T0)、术后4 h(T1)、术后12 h(T2)及术后24 h(T3)认知功能的变化,并比较两组不良反应情况。结果异丙酚组患者的自主呼吸恢复时间、睁眼时间和拔管时间明显短于七氟醚组(P<0.05)。两组患者T1和T2时MMSE评分均较T0时明显下降(P<0.05);且七氟醚组患者下降幅度较异丙酚组更明显(P<0.05);两组患者T3时MMSE评分均恢复至T0时水平(P>0.05)。观察组与对照组分别出现不良反应3例(7.50%)、5例(12.50%),症状均较轻,两组比较差异无统计学意义(χ2=0.14,P>0.05)。结论与七氟醚吸入麻醉相比,异丙酚静脉麻醉用于老年输尿管镜患者术后具有苏醒速度快、呼吸恢复快、拔管时间早、认知功能影响较少及安全性较好等优点。

Objective To investigate the effects of propofol and sevoflurane anesthesia on the postoperative awakening quality and cognitive function of anesthesia in elderly patients undergoing ureteroscopic surgery. Methods 80 elderly patients with elective ureteroscopy from January 2015 to December 2017 were enrolled. The patients were divided into propofol group and sevoflurane group, with 40 patients in each group. The propofol group and sevoflurane group were treated with propofol intravenous anesthesia and sevoflurane inhalation anesthesia, respectively. The quality of awakening after anesthesia was observed in both groups, and the changes in cognitive function before anesthesia(T0), 4 h (T1), 12 h (T2) and 24 h (T3) were evaluated, and adverse reactions were compared. Results The spontaneous breathing recovery time, blink time and extubation time were significantly shorter in the propofol group than those in the sevoflurane group(P<0.05). The MMSE scores of T1 and T2 in the two groups were significantly lower than those in T0(P<0.05). The decrease of sevoflurane group was more obvious than that in propofol group(P<0.05). The MMSE scores of the two groups at T3 were restored to that at T0 level(P>0.05). There were 3 cases(7.50%) and 5 cases(12.50%) of adverse reactions in the observation group and the control group. And the symptoms were mild. There was no significant difference between the two groups(χ^2=0.14, P>0.05). Conclusion Compared with sevoflurane inhalation anesthesia, propofol intravenous anesthesia is used for elderly ureteroscopy patients with fast recovery, rapid recovery of breathing, early extubation time, less cognitive function and better safety.