不同麻醉方式对老年女性腹腔镜手术患者术后认知功能的影响

目的 探讨不同麻醉方式对老年妇科腹腔镜手术患者术后认知功能的影响。 方法 选取老年患者60例，择期行妇科腹腔镜全子宫切除手术，根据随机对照原则，分为丙泊酚靶控输注麻醉组（P组）和七氟烷吸入麻醉组（S组），每组30例。比较2组患者呼吸恢复时间、苏醒时间及拔管时间；术前24 h及术后6 h、24 h、72 h及7 d采用简易智力状态检查量表（mini-mental stateexamination，MMSE）进行认知功能测定；术前24 h、术后24 h和72 h，采用ELISA法测定白细胞介素6（interleukin- 6，IL-6）和S100β蛋白。 结果 术后2组患者MMSE评分呈先降后升趋势，P组MMSE评分在术后6 h、24 h和72 h均高于S组(P＜0.05)。P组患者术后24 h和72 h 术后认知功能障碍（postoperative cognitive dysfunction，POCD）发生率低于S组(P＜0.05)。2组血浆IL-6浓度呈上升趋势，P组IL-6浓度在术后24 h和72 h显著低于S组(P＜0.05)。2组S100β蛋白水平呈先升后降趋势，P组S100β蛋白水平在术后24 h显著低于S组(P＜0.05)；术后72 h，2组患者S100β蛋白降至术前水平，P组不良反应发生率低于S组(P＜0.05)。 结论 在老年患者妇科腹腔镜全子宫切除手术中，与七氟烷吸入麻醉相比，丙泊酚静脉麻醉对患者术后认知功能影响较小，苏醒快，不良反应少，更适合于老年患者的麻醉。

Effects of different anesthesia methods on postoperative cognitive function of elderly patients undergoing gynecological laparoscopic surgery

Objective To explore the effects of different anesthesia methods on the postoperative cognitive function of elderly patients undergoing gynecological laparoscopic surgery.Methods A total of 60 elderly patients were selected for elective gynecological laparoscopic hysterectomy. According to the principle of randomized control, they were divided into two groups: target-controlled infusion of propofol anesthesia group(group P) and sevoflurane inhalation anesthesia group(group S). In terms of indicators, the respiratory recovery time, recovery time and extubation time of the two groups of patients were compared. The mini-mental state examination(MMSE) was used for cognitive function measurement at 24 h before operation and at 6 h, 24 h, 72 h and 7 d after operation. At 24 h before operation, 24 h and 72 h after operation, IL-6 and S100β protein were measured by enzyme-linked immunosorbent assay（ELISA）.Results After operation, the MMSE scores of the two groups were decreased initially and then increased. The MMSE scores of group P were higher than those of group S at 6 h, 24 h and 72 h after operation(P＜0.05). The incidence of postoperative cognitive dysfunction（POCD） at 24 h and 72 h after operation in group P was lower than that in group S(P＜0.05). The plasma IL-6 concentration of the two groups showed a rising trend. The IL-6 concentration of group P was significantly lower than that of group S at 24 h and 72 h after surgery(P＜0.05). The S100β protein level of the two groups was increased initially and then decreased. The S100β protein level of group P was significantly lower than that of group S at 24 h after operation(P＜0.05); at 72 h after operation, the S100β protein of the two groups was decreased to the preoperative level.The incidence of adverse reactions in group P was lower than that in group S(P＜0.05).Conclusion Compared with sevoflurane inhalation anesthesia in elderly patients undergoing gynecological laparoscopic total hysterectomy, propofol intravenous anesthesia has fewer effects on postoperative cognitive function, with quick recovery and fewer adverse reactions. Therefore, it is more preferable for anesthesia in elderly patients.