静脉麻醉与吸入麻醉对老年患者术后认知功能的影响

Effect of intravenous anesthesia versus inhalation anesthesia on postoperative cognitive function in elderly patients

目的比较静脉麻醉与吸入麻醉对老年患者术后认知功能的影响。方法将本院行外科手术的160例老年患者按照随机数表法分为静脉麻醉组和吸入麻醉组。静脉麻醉组采用芬太尼0.1μg/(kg·min)及丙泊酚4 mg/(kg·h)静脉麻醉维持,吸入麻醉组采用50%一氧化二氮及七氟烷吸入麻醉维持。采用简明精神状态量表(MMSE)于术前及术后1、4、12、24 h评估患者的认知功能评分,观察并记录患者的拔管时间、苏醒时间及应答时间。结果术前2组患者MMSE评分差异无统计学意义(P>0.05);术后1、4、12及24 h,静脉麻醉组的MMSE评分高于吸入麻醉组,差异有统计学意义(P<0.05);2组患者术中出血量、输血例数、手术时间、低血压及术后恶心、呕吐发生率比较差异均无统计学意义(P>0.05);静脉麻醉组患者拔管时间、应答时间及苏醒时间均显著短于吸入麻醉组(P<0.05)。结论与吸入麻醉相比,静脉麻醉能够显著缩短老年患者术后拔管时间、应答时间及苏醒时间,减弱麻醉对患者认知功能的影响。

Objective To compare the effect of intravenous anesthesia and inhalation anesthesia on postoperative cognitive function in elderly patients.Methods A total of 160 elderly patients undergoing surgery in ouRhospital were randomly divided into intravenous anesthesia group and inhalation anesthesia group according to random numbeRtable method.The intravenous anesthesia was maintained by 0.1 g/kg(kg·min)of fentanyl and 4 mg/(kg·h)of propofol in the intravenous anesthesia group,and by 50%N 2O and sevoflurane inhalation in inhalation anesthesia group.The Mini-mental State Examination(MMSE)was used to assess the score of cognitive function of patients before surgery and 14,12 and 24 h afteRsurgery.The extubation time,awake time and response time were observed and recorded.Results Before surgery,there was no significant difference in MMSE score(P>0.05);at 14,12 and 24 h afteRsurgery,MMSE scores of intravenous anesthesia group were significantly higheRthan that of inhalation anesthesia group(P<0.05);there were no statistically significant differences in the amount of intraoperative blood loss,numbeRof transfusion cases,operation time,occurrence of hypotension,and the incidence of postoperative nausea and vomiting between the two groups(P>0.05);the extubation time,response time and awaking time of patients in the intravenous anesthesia group were significantly shorteRthan those in the inhalation anesthesia group(P<0.05).Conclusion Compared with inhaled anesthesia,intravenous anesthesia can significantly shorten the postoperative extubation time,response time and awake time of elderly patients,and reduce the impact of anesthesia on patients'cognitive function.