七氟醚吸入全麻对高龄手术患者术后认知功能的影响

目的 研究七氟醚吸入全麻对高龄手术患者术后认知功能的影响.方法 选择2013年1月～2014年6月普外科老年手术患者236例,采用隐匿数字随机法分为两组,分别采用七氟醚吸入全麻和丙泊酚静脉全麻,比较两组患者术后认知功能.结果 两组术后睁眼时间、拔管时间、应答时间比较差异无统计学意义（P＞0.05）.七氟醚组术后1h、6 h MMSE评分低于丙泊酚组（P＜0.01）,24h后逐渐恢复,72 h后基本恢复至术前水平（P＞0.05）.两组术后1h均发生术后认知功能障碍（POCD）,七氟醚组术后6h POCD发生率为58.47％,明显高于丙泊酚组的29.66％（P＜0.01）.术后24h、72h POCD发生率比较差异无统计学意义（P＞0.05）.结论 七氟醚吸入全麻对高龄患者术后认知功能影响有限,72 h后可基本恢复至术前水平.建议术前积极消除患者认知功能障碍的影响因素,以提高高龄患者手术麻醉的安全性.

Effect of sevoflurane inhalation anesthesia on the postoperative cognitive function of aged patients

Objective To study the effect of sevoflurane inhalation anesthesia on postoperative cognitive function of aged patients.Methods 236 aged patients underwent operation in the General Surgery Department from January,2013 to June, 2014 were divided into two groups according to hidden random number table.The two groups were given sevoflurane inhalation anesthesia （sevoflurane group） and propofol intravenous anesthesia （propofol group） ,respectively.Then,postoperative cognitive functions of two groups were compared.Results Differences in postoperative eye-opening time,extubation time and response time of two groups were not statistically significant （P〉0. 05）.MMSE scores of the sevoflurane group at 1 h and 6 h after surgery were obviously lower than those of the propefol group（P〈0. 01 ） ;they gradually recovered 24 h later, and basically returned to pre-operation level 72 h later.POCD （ postoperative cognitive dysfunction） was found in both groups 1 h later.The incidence of POCD in the sevoflurane group 6 h later after operation was 58.47%, obviously higher than that（ 29.66% ） in the propofol group（P〈O. 01 ）.Difference of incidence of POCD at 24 h and 72 h after operation was not statistically significant （P〉O. 05）.Conclusion Sevoflurane inhalation anesthesia has limited effect on the cognitive function of aged patients after operation,but the cognitive function can basically return to pre-operation level 72 h later after operation.Influential fac- tors of cognitive impairment should be actively eliminated before operation, so as to improve the safety of surreal anesthesia for aged patients.