全静脉麻醉与静吸复合麻醉对老年患者术后认知功能的影响

目的探讨丙泊酚与瑞芬太尼、异氟醚与丙泊酚维持麻醉对老年患者术后认知功能恢复的影响。方法 60例ASAⅠ～Ⅱ级老年腹部手术患者随机分为两组,全静脉组(A组n=30)、静吸复合组(B组n=30)。两组麻醉诱导方法相同:芬太尼2μg/kg、依托咪酯0.2mg/kg、阿曲库铵0.5mg/kg诱导插管,分别以瑞芬太尼5～8μg/kg和丙泊酚6～8mg/kg、1.0MAC的异氟醚和丙泊酚6～8mg/kg维持麻醉,分别观察患者术前、术后1,6,12,24,48h认知功能MMS值的变化。结果全静脉组在术后1～12h三个时间点MMS值降低(p<0.05),24h及48h与术前无差异(p>0.05);静吸复合组在术后1～24h四个时间点MMS值降低(p<0.05),48h与术前无差异(p>0.05);在术后1,6h两个时间点静吸复合组相比全静脉组MMS值降低(p<0.05)。结论在术后认知功能的恢复方面,丙泊酚与瑞芬太尼用于老年病人麻醉较异氟醚与丙泊酚更优。

COMPARE PROPOFOL AND REMIFENTANIL COMPOSITE TOTAL INTRAVENOUS ANESTHESIA WITH PROPOFOL AND ISOFLURANE INDUCTION-INTRAVENOUS ANESTHESIA ON POSTOPERATIVE COGNITIVE FUNCTION OF ELDERLY PATIENTS

Objective To evaluate the effect of propofol and remifentanil composite total intravenous anesthesia with propofol and isoflurane induction-intravenous anesthesia on postoperative cognitive dysfunction（POCD）of elderly patients.Methods 60 ASA III elderly patients undergoing abdominal surgery were randomly allocated into 2 groups （n=30）;Group A：propofol combined with remifentanil total intravenous anesthesia;Group B：propofol combined with isoflurane induction-intravenous anesthesia.Anesthesia was induced with etomidate 0.2 mg/kg、fentanyl 2 μg/kg and atracurium 0.5 mg/kg all for tracheal intubation.Group A was maintained with infusion remifentanil（58 μg/kg） and propofol （68 mg/kg）,Group B was maintained with infusion propofol （68 mg/kg） and induction isoflurane（1.0MAC）,intermittent iv boluse of atracurium for all patients.MMS of cognitive function at before operation and 1 h,6 h,12 h,24 h,48 h after operation were recorded.Results Group A：MMS of cognitive function at1,6,12 h after operation were lower than before operation（p〈0.05）,no difference for 24,48 h after operation and before operation（p〉0.05）;Group B：MMS of cognitive function at1 h,6 h,12 h,24 h after operation were lower than before operation（p〈0.05）,no difference for 48 h after operation and before operation（p〉0.05）;MMS of cognitive function at1 h,6 h,after operation,group B was lower than group A（p〈0.05）.Conclusion Compare recovery on postoperative cognitive function,propofol combined with remifentanil total intravenous anesthesia was better than propofol combined with isoflurane induction-intravenous on elderly patient anesthesia.