丙泊酚与七氟醚对老年患者日间手术后早期认知功能的影响

Effects of propofol and sevoflurane on early congnitive function of elderly patients after ambulatory surgery

目的探讨丙泊酚和七氟醚两种麻醉维持方式对老年患者日间手术后早期认知功能的影响。方法选择日间手术的腹腔镜胆囊切除术老年患者60例,按随机数字表法分为七氟醚组和丙泊酚组(每组30例)。分别于术前1 d和术后24 h进行神经心理学测试评分;麻醉诱导前和术后24 h抽取静脉血,采用ELISA法测定血浆胰岛素样生长因子1(insulin like growth factor 1,IGF 1)含量及血清IL 6、IL 1β、TNF α含量;比较两组患者术前、术后量表评分及炎症因子变化情况。结果两种麻醉维持方式均造成部分患者术后出现神经认知功能改变,其中七氟醚组2例(6.9%),丙泊酚组2例(6.7%),两组间发生率比较差异无统计学意义(P>0.05);两组间术前、术后神经心理学测试评分差异无统计学意义(P>0.05);两组患者麻醉诱导前及术后24 h炎性因子含量差异无统计学意义(P>0.05)。结论两种全身麻醉维持方式对老年患者日间手术后早期认知功能改变无影响,对术后24 h血液炎性因子水平也无影响。

Objective To investigate the effects of two approaches of anesthesia maintenance,propofol and sevoflurane,on early cognitive function of elderly patients after ambulatory surgery.Methods Sixty elderly patients who were scheduled for laparo scopic cholecystectomy as ambulatory surgery were selected.The patients were divided into two groups according to the random num ber table method(n=30):a propofol group and a sevoflurane group.Neuropsychological test scores were recorded one day before sur gery and 24 h after surgery respectively.Venous blood was extracted before anesthesia induction and 24 h after surgery.The levels of plasma insulin like growth factor 1(IGF 1),serum interleukin(IL) 6,IL 1βand tumor necrosis factor α(TNF α)were determined by enzyme linked immunosorbent assay(ELISA).Both groups were compared for the scale scores and inflammatory factor changes before and after surgery.Results Both approaches of anesthesia maintenance could result in postoperative neurocognitive function chang es in some patients,including 2 cases(6.9%)in the sevoflurane group and 2 cases(6.7%)in the propofol group,without statistical dif ference in the incidence between the two groups(P>0.05).There was no statistical difference in neuropsychological test scores between the two groups before and after surgery(P>0.05).There was no statistical difference in the levels of inflammatory factors between the two groups before anesthesia induction and 24 h after surgery(P>0.05).Conclusions These two approaches of general anesthesia maintenance have no effect on the changes of early cognitive function in elderly patients after ambulatory surgery,without effect on the levels of blood inflammatory factors 24 h after surgery.