七氟烷和丙泊酚麻醉对老年食管癌根治术后认知功能的影响

Influence of Sevoflurane and Propofol Anesthesiology on Cognitive Function of Elderly Patients with Esophageal Carcinoma after Radical Resection

目的探讨七氟烷和丙泊酚麻醉对老年食管癌根治术后认知功能的影响。方法将214例老年食管癌患者按照随机数字表法随机分为七氟烷组及丙泊酚组各107例,经依托咪酯等静脉快速麻醉诱导后,七氟烷组持续吸入七氟烷进行麻醉维持,丙泊酚组静脉给予丙泊酚麻醉维持。分别于术前24 h,术后1天,术后3天,术后7天应用简易智力状况监测表(MMSE)评估患者认知功能情况,并于术前、术后10 min及术后24 h抽取静脉血检测S100β的表达。结果七氟烷组手术时间为(129.1±14.6)min,丙泊酚组手术时间为(132.4±17.1)min,2组比较无统计学差异(P>0.05)。七氟烷组麻醉时间(158.3±21.4)min,丙泊酚组麻醉时间(162.5±20.9)min,2组比较无统计学差异(P>0.05)。丙泊酚组术后1 h、术后3 h MMSE评分与术前比较,差异具有统计学意义(P<0.05)。七氟烷组术后1 h、术后3 h、术后6 h MMSE评分与术前比较,差异具有统计学意义(P<0.05)。丙泊酚组术后1 h、3 h、6 h MMSE评分与七氟烷组比较,差异具有统计学意义(P<0.05)。术后丙泊酚组与七氟烷组S100β蛋白均较术前有显著差异(P<0.05)。丙泊酚组与七氟烷组术后S100β蛋白比较差异具有统计学意义(P<0.05)。结论丙泊酚与七氟烷均可影响高龄食管癌根治手术患者的术后认知功能,但与七氟烷相比,丙泊酚对术后认知功能障碍的影响更小,恢复更快。

Objective To investigate the influence of sevoflurane and propofol anesthesiology on cognitive function of elderly patients with esophageal carcinoma after radical resection. Methods 214 elderly patients with esophageal cancer were randomly divided into the sevoflurance group and propofol group,each with 107 cases. After rapid intravenous etomidate induction of anesthesia,sevoflurane group were continued to maintain sevoflurane anesthesia,propofol group were continued to maintain propofol anesthesia. The cognitive function 24 h before surgery,1 day,3 days and 7 days after surgery were evaluated by MMSE.The S100β expression in venous blood preoperative,postoperative 10 min and 24 h were detected. Results The operative time of the sevoflurance group was( 129. 1 ± 14. 6) min,while in the propofol group was( 132. 4 ± 17. 1) ml,which had no significant difference( P > 0. 05). The anesthesia time of sevoflurance group was( 158. 3 ± 21. 4) min,that of the propofol group was( 162. 5± 20. 9) min,there had no significant difference( P > 0. 05). The MMSE score of sevoflurance group at 1 h,3 h,6 h before and after surgery had significant difference( P < 0. 05). The MMSE score of propofol group at 1 h,3 h,6 h before and after surgery had statistically difference( P < 0. 05). The MMSE scores of the 2 group at 1 h,3 h,6 h after surgery had statistically difference( P <0. 05). The S100β protein of sevoflurane group and propofol group before and after surgery had significant difference( P < 0. 05).The S100β protein of the 2 groups had statistically difference( P < 0. 05). Conclusion Sevoflurane and propofol both have influence on cognitive function of elderly patients with esophageal cancer after radical resection. Compared with sevoflurance,propofol had less influence on postoperative cognitive dysfunction and fast recovery.