医药学论文：丙泊酚和异氟烷对老年病人全麻术后认知功能影响的比较

【摘要】 目的 研究应用丙泊酚和异氟烷麻醉对老年病人认知功能的影响。方法 选择ASAⅠ～Ⅱ级、无心脑血管疾病且未服用影响神经精神系统功能的药物在青岛大学医学院附属医院行择期非心脏手术的病人30例，随机分为两组，每组15例，分别接受丙泊酚（P组）和异氟烷（I组）麻醉。两组病人麻醉诱导均采用静脉注射丙泊酚1.5~2.0mg/kg，芬太尼3~4μg/kg，维库溴铵0.1mg/kg。麻醉维持：P组静脉泵注丙泊酚100~150μg/（kg·min），I组吸入1%~2%异氟烷。术中监测麻醉深度，并根据BIS值调整用药量。术后镇痛采用病人自控静脉镇痛，方法为芬太尼8μg/ml，持续给药2ml/h，病人自控镇痛给药0.5ml/15min，镇痛效果采用视觉模拟评分（VAS）评估。记录术前、插管5min、切皮、拔管5min、术后1h、4h、24h、48h病人生命体征变化，并于术前及术后1h、4h、24h、48h，采用简易智力状态检查（mini-mental state examination，MMSE）评估病人认知功能。记录两组病人手术时间、出血量、输血量和输液量。结果 试验纳入病人30例，全部进入结果分析，中途无脱落。两组病人一般资料、手术时间、术中输血输液量及出血量、各观察点生命体征以及病人自控镇痛效果视觉模拟评分组间比较，差异无显著性（P＞0.05）。术后1h两组MMSE评分及术后4h I组MMSE评分均较术前明显下降，差异有显著性（P＜0.05），术后4h P组MMSE评分较术前有所下降，但差异无显著性（P＞0.05），术后4h I组较P组MMSE评分下降，差异有显著性（P＜0.05）。术后24h及48h两组MMSE评分与术前比较差异无显著性（P＞0.05）。结论 接受丙泊酚或异氟烷麻醉的病人采用MMSE评估认知功能，病人术后短期内均出现认知功能的降低。

 

　　【关键词】 丙泊酚；异氟烷；老年人；认知功能

 

Comparison of the Cognitive function of the influence in elder patients with propofol and isoflurance after general anesthesia

 

【Abstract】 Objective To investigate the influence of propofol and isoflurane on the cognitive function in elderly patients.Methods 30 ASAⅠ～Ⅱpatients，scheduled for elective abdominal surgery in the HospitalAffiliated to the Medical College of Qingdao Universitywere selected.All the patients have no cardiac or neuropsychiatric diseases or history of taking corresponding mediciens.The patients were divided into propofol （P group） and isoflurane subgroups （I group）（n=15 in each subgroup）.Anesthesia was induced with intravenous propofol 1.5~2.0mg/kg，fentanyl 3~4μg/kg，vecuronium 0.1mg/kg，and maintained with intravenous propofol 100~150μg/（kg·min）or isoflurane inhalation （1%~2%） modulated by BIS.The hemodynamic parameters （MAP、HR、SPO2） were recorded before surgery and at the time of 1h、4h、24h、48h after operation.Mini-mental state examination was performed before anesthesia and 1h、4h、24h、48h after operation.The volume of liquid and blood received and lost during the operation were also recorded.Results All the 30 patients were involved in the analysis of results.There were no significant differences between the two groups in age、height、weight and sex ratio.No difference in the hemodynamic parameters （MAP、HR、SPO2） in the same perioperative period of the volume of liquid and bloodthat patients lost and received during the operation was found when compared between subgroups.In all patients，the MMSE scores at 1h after operation were significantly lower than the baseline value （P＜0.05）.The MMSE scores at 4h after operation in I group patients were significantly longer than that inP group （P＜0.05）.There were no significant differences between the MMSE scores at 24 or 48h after operation of the baseline value（P＞0.05）.Conclusion