【2017年整理】不同麻醉用药对老年患者麻醉后苏醒时间及术后认知功能的影响对比.docxVIP

不同麻醉用药对老年患者麻醉后苏醒时间及术后认知功能影响的对比 摘要：目的 对比七氟烷和异氟烷对老年患者腹部手术后苏醒时间及认知功能的影响。方法 选择在我院行择期腹部手术的患者98例，ASA Ⅰ~Ⅲ级，中位年龄68（61~78）岁，随机分为七氟烷组（S组）和异氟烷组（I组），每组49例。记录两组患者苏醒时间、拔管时间以及定向力恢复时间，并使用简易精神状态量表（MMSE）分别对两组患者在术前1d和术后1、3、6及24小时进行评分（总分30分），24分为术后认知功能障碍（POCD）。结果 两组患者平均苏醒时间无差别（P 0.05），七氟烷组的平均拔管时间及定向力恢复时间少于异氟烷组（P 0.05）。两组患者在术后1小时及3小时，MMSE评分均低于术前基线水平（P 0.05），而异氟烷组较七氟烷组更低（P 0.05），术后6小时及24小时时，两组患者评分与基线水平无差异，两组之间也无明显差异（P 0.05）。术后1小时及3小时，七氟烷组的POCD发生率明显低于异氟烷组（P 0.05）；术后6小时及以后，两组之间POCD发生率无明显差异（P 0.05）。结论 在老年患者腹部手术中，使用七氟烷麻醉的拔管及定向力恢复时间少于异氟烷，在麻醉后6小时内，七氟烷对于患者术后认知功能恢复较异氟烷更有优势。 关键词：七氟烷；异氟烷；麻醉；术后认知功能紊乱 中图分类号：R-614 R614.2 文献标识码：A Comparison of cognitive function and recovery after sevoflurance or isoflurance anaesthesia in the elderly patiennts ABSTRACT: Objective To compare postoperative recovery and cognitive function after sevoflurance or isoflurance anaesthesia in elderly patients. Methods 98 ASA physical status I~III consenting elderly patients (median age 68) undergoing abdominal operation were randomly assigned to either sevoflurance or isoflurance anesthetic groups. Emergence time, extubation time and Recovery time were recorded. The Mini-Mental State Examination (MMSE) was administered to evaluate cognitive function at baseline and at 1, 3, 6, and 24-h postoperatively. The maximum score is 30 points, with scores of 24 indicative of cognitive impairment. Results The mean emergence time was similar between the two groups, whereas the mean tracheal extubation time and recovery time were longer in the isoflurance group. The preoperative baseline MMSE values was similar between the two groups, the mean MMSE scores were significantly decreased at 1h and 3h postoperatively in both groups, whereas the sevoflurane group has more higher than isoflurance the group. The mean MMSE scores of the patients in both groups had returned to their baseline levels at 6h and 24h postoperatively. At 24h postoperatively, all the patients (except one in the Sevoflurane group) had returned to their baseline MMS sco