七氟烷吸入麻醉对老年患者微创手术后认知功能和术后谵妄的影响

Effects of sevoflurane inhalation anesthesia on cognitive function and postoperative delirium in elderly patients undergoing minimally invasive surgery

目的观察七氟烷吸入麻醉对老年患者微创手术后认知功能和术后谵妄的影响。方法选取2022年10月—2023年10月于阳江市人民医院行腹腔镜胆囊切除术的老年患者80例作为研究对象,按照随机数字表法分为观察组(七氟烷吸入麻醉)与对照组(丙泊酚泵注麻醉),每组40例。检测患者手术前后外周血清中枢神经特异蛋白(S100β)水平;采用简易智力状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)评估患者手术前后认知功能;根据谵妄评估量表(CAM)评分判定术后谵妄状态,统计术后谵妄发生率。比较两组患者上述观察指标的差异。结果术后,观察组血清S100β水平显著低于对照组(P<0.05),认知功能评分(MMSE、MoCA评分)显著高于对照组(P<0.05)。观察组谵妄术后发生率为5%,低于对照组的10%,但差异无统计学意义(P>0.05)。结论七氟烷吸入麻醉对中枢神经细胞有保护作用,可有效减少对老年患者微创手术后认知功能的影响,不会额外增加术后谵妄发生率。

Objective To observe the effects of sevoflurane inhalation anesthesia on cognitive function and postoperative delirium after minimally invasive surgery in elderly patients.Methods A total of 80 elderly patients who underwent laparoscopic cholecystectomy in Yangjiang People's Hospital from October 2022 to October 2023 were selected as study subjects.According to the random number table method,they were divided into an observation group(sevoflurane inhalation anesthesia)and a control group(propofol pump injection anesthesia),with 40 patients in each group.The serum central nervous system specific protein(S100β)level was detected before and after surgery;the cognitive function was evaluated using the mini-mental state examination(MMSE)and the Montreal cognitive assessment(MoCA)before and after surgery;the postoperative delirium was determined according to the confusion assessment method(CAM)score,and the incidence of postoperative delirium was calculated.The differences in the above observation indicators were compared between the two groups.Results After surgery,the S100βlevel in the observation group was significantly lower than that in the control group(P<0.05).The postoperative cognitive function scores(MMSE and MoCA scores)in the observation group were significantly higher than those in the control group(P<0.05).The incidence of postoperative delirium in the observation group was 5.00%,lower than 10.00%in the control group,but the difference between the groups showed no statistically significance(P>0.05).Conclusion Sevoflurane inhalation anesthesia has a protective effect on central nervous cells,which can effectively reduce the impact on cognitive function after minimally invasive surgery in elderly patients,and will not increase the incidence of postoperative delirium.