瑞芬太尼与芬太尼对老年人全身麻醉术后认知功能影响的比较

目的:研究比较瑞芬太尼与芬太尼对老年患者全身麻醉术后早期认知功能的影响。方法:ASAⅠ～Ⅱ级择期行非心脏手术老年患者60例,随机分为R、F两组,每组30例。全身麻醉维持分别用1～2μg/(kg·min)瑞芬太尼(R组)或2～3μg/(kg·h)芬太尼(F组),麻醉深度维持血压(Bp)在基础值的±10%,记录手术后睁眼时间、拔管时间、语言应答时间等麻醉恢复指标,并于麻醉前1d、术后2h、4h、6h、24h采用简易智力状态检查(MMSE)评价认知功能。结果:两组患者年龄、身高、体重、手术时间、麻醉时间、麻醉药用量均无显著差异(P>0.05);R组患者术后睁眼时间、拔管时间、拔管后语言应答时间均早于F组(P<0.05);术后2h两组MMSE评分较术前均明显下降(P<0.05),R组患者术后4hMMSE评分基本恢复正常,而F组直到术后6h才有20%患者基本恢复正常,术后24hR组所有患者MMSE评分均已达术前水平,而F组则是85%患者MMSE评分恢复达术前水平。结论:瑞芬太尼与芬太尼均可引起老年患者术后短暂的认知功能障碍,但瑞芬太尼较芬太尼恢复更快,对老年人术后认知功能阻碍的作用小于芬太尼。

Influence of remifentanil and fentanyl for general anesthesia on the postoperative cognitive function in elderly patients

Objective To explore the effects of remifentanil and fentanyl for general anesthesia on the postoperative cognitive function in elderly patients.Method Sixty ASA physical status Ⅰ ～ Ⅱ consenting elderly patients were randomly assigned to two general anesthetic groups.Following induction of anesthesia,remifentanil 1 ～ 2 μg/（kg·min） （group R） or fentanyl 2 ～ 3 μg/（kg·h） （group F） were adjusted to maintain comparable depth of hypnosis.The time for eye opening,extubation and verbalization after operation were recorded.The mini-mental state examination （MMSE） was used to assess cognitive function preoperatively and 2,4,6,24 h after operation.Results No significant differences were found between the tow groups in age,sex,height,body weight,duration of anesthesia or surgery.The time for eye opening,extubation and verbalization were markedly shorter in group R.MMSE scores were significantly reduced in both group at 2 h after operation,and recovered to the preoperative level at 4 h in group R,but 20% at 6 h in group F.Conclusion Both remifentanil and fentanil can result in postoperative cognitive dysfunction in elderly patients,though the recovery is faster after the use of remifentanil than that of fentanil.