两种全身麻醉方法对老年患者术后认知功能的影响

目的比较异氟醚静吸复合麻醉与持续输注丙泊酚静脉麻醉对老年患者术后认知功能的影响。方法择期全身麻醉下行腹部手术老年患者40例,分为两组：异氟醚组（I组）和丙泊酚组（Ⅱ组）;I组术中吸入1-2 MAC异氟醚维持麻醉;Ⅱ组术中静脉输注丙泊酚0.06-0.2 mg/（kg.min）^-1维持麻醉,采用简易精神状态量表（MMSE）于术前1 d、术后1 h,4 h,24 h及术后4 d对患者进行评分,记录老年患者围术期的认知功能变化情况。结果两组患者认知功能评分在术后1 h时均有明显下降,且异氟醚组下降较丙泊酚组明显;术后4 h时异氟醚组患者认知功能较术前仍有下降,而丙泊酚组患者认知功能基本恢复至术前水平;两组患者术后24 h、术后4 d时认知功能比较无明显差异。结论异氟醚及丙泊酚对老年患者术后认知功能在短期内均有一定影响,异氟醚麻醉的影响程度较大,持续时间也较长。

Effect of Two General Anesthesia Methods on Postoperative Cognitive Dysfunction of Senile Patients

Objective To compare effect of Isoflurane combined anesthesia by vein with inhalation and intravenous anesthesia by continuous infusion of Propofol on postoperative cognitive dysfunction（POCD） of senile patients.Methods Forty cases of senile patients who were going to be operated on abdomen under general anesthesia,were divided into two groups,Isoflurane group（group Ⅰ） and Propofol group（group Ⅱ）.In group Ⅰ,Isoflurane 1 to 2 MAC were inhaled for anesthesia maintenance during the operation.And in group Ⅱ,anesthesia maintenance in the operation was carried out by infusion of Propofol 0.06-0.2（mg/kg·min）-1 in vein.Mini-mental state examination（MMSE） was taken to give patients＇ marks one day before operation.Results After operation 1 hour,4 hours,24 hour,and it was more evident in group Ⅰthan in group Ⅱ.After operation 4 hours,it recovered to some extent in group Ⅰ,but it reduced comparing with that before operation,while in group Ⅱ,it recovered to reach the level before operation.There was no obvious difference in cognitive function after operation 24 hours and 4 days between the two groups.Conclusions Isoflurane and Propofol have some effects on postoperative cognitive function of senile patients in short term.Isoflurane anesthesia has much more effect with longer duration.