异氟醚和异丙酚对老年患者术后认知功能的影响

目的比较异氟醚和异丙酚全身麻醉对老年患者术后早期认知功能的影响。方法择期将ASAⅠ~Ⅱ麻醉下行腹部外科手的70例老年患者随机分为异氟烷组（I组n=35）和异丙酚组两组（P组n=35）。两组麻醉诱导方式相同：咪达唑伦0.03mg/kg,芬太尼2μg/kg,依托咪酯0.2mg/kg,维库溴铵0.1mg/kg诱导插管,分别以1.5~2MAC的异氟醚和3~6mg/kg.h异丙酚维持麻醉,使用简易智能量表（mini-mental state examination,MMSE）评估患者术前,术后12、24、48h认知功能变化。结果两组患者MMSE评分在术后12、24、48h均较术前降低（P〈0.05）,在术后12h、24h异丙酚组MMSE评分较异氟醚高（P〈0.05）,异丙酚组认知功能的发生率在术后24h较异氟醚低（P〈0.05）,术后12、48h无差异（P〉0.05）。结论异丙酚比异氟醚全身麻醉能提高老年患者术后早期MMES值,减少老年患者术后认知功能障碍的发生。

Influence of isoflurane and propofol on cognitive of aged patients

Objective To compare the cognitive function after isoflurane and propofol anesthesia in aged patients.Methods 70 aged patients received abdominal surgery under general anesthesia were randomly assigned into two groups.Following the induction,isoflurane（group I） or propofol（group P） was respectively given to maintain the anesthesia.The postoperative mini-mental state examination（MMSE） and the parameters of the hemodynamics were recorded.Results The preoperative MMSE was better than any of the postoperative one in both groups（P0.05）.The MMSE was better in propofol group in either of the 12h or 24h after operation（P0.05）.The incidence of postoperative cognitive dysfunction（POCD） in propofol group was lower 24h after the surgery（P0.05）,there was no significant different POCD incidence between two groups 12h or 48h after the surgery（P0.05）.Conclusion Both isoflurane and propofol may contribute to the POCD in aged patients,but the propofol anesthesia can result in better postoperative MMSE and lower incidence of POCD than isoflurane.