不同全身麻醉方式对老年消化道肿瘤患者手术后早期认知功能的影响  

Various anesthetic approaches on early cognition in elderly patients who underwent gastrointestinal cancer surgery

作　　者：宋瑞凤[1,2] 程桥[1] 田首元[3] 王建华[4] 

机构地区：[1]山西医科大学麻醉学系,太原030001 [2]山西省长治市城区人民医院麻醉科 [3]山西医科大学第一医院麻醉科 [4]长治医学院基础医学部

出　　处：《中国药物与临床》2012年第7期870-872,共3页Chinese Remedies & Clinics

基　　金：山西省卫生厅科技攻关计划项目(20100103)

摘　　要：目的比较不同全身麻醉方式对老年患者消化道肿瘤手术后早期认知功能的影响。方法随机选择90例无神经精神系统疾病史或服用相应药物的消化道肿瘤患者,美国麻醉医师协会(ASA)Ⅰ～Ⅱ级,年龄60～79岁,采用随机数字表法,将择期行消化道肿瘤手术患者随机分为3组(每组30例):异丙酚全凭静脉组(P组)、七氟醚与异丙酚静吸复合组(SP组)、七氟醚吸入麻醉组(S组)。分别于术前1d、出麻醉恢复室时及术后1、3、7d时,采用简易精神状态评价量表(MMSE)进行认知功能评分。结果与术前1d比较,P组、SP组、S组出麻醉恢复室时、术后1d时MMSE评分降低(P<0.05),出麻醉恢复室时、术后1d时认知功能障碍发生率升高(P<0.05);术后3、7d时MMSE评分有所恢复,虽较术前略下降,但差异无统计学意义(P>0.05);P组、SP组、S组间MMSE评分和术后认知功能障碍发生率差异无统计学意义。结论老年患者全身麻醉术后早期认知功能下降,不同全身麻醉方式早期认知功能障碍发生率差异无统计学意义。Objective To compare the impact of various anesthetic approaches on early cognition in elderly patients who underwent gastrointestinal cancer surgery.Methods Ninety patients（ASA Ⅰ-Ⅱ） who were scheduled for elective gastrointestinal cancer surgery,aged 60-79 years and have neither history of neurological or psychiatric disease nor on anti-tumor medication were randomly assigned into group P（n=30） to receive propofol intravenous injection,group SP（n=30） to be treated with sevoflurane and propofol inhalation,group S（n=30） to undergo sevoflurane anesthesia,on the basis of random number table.Cognition was assessed using MMSE scale at day 1 preoperatively,during the stay in anesthesia recovery room and at days 1,3 and 7 postoperatively,respectively.Results Groups S,P and SP yielded reduced MMSE score and higher incidence of cognitive dysfunction during the stay in anesthesia recovery room and at day 1 postoperatively as compared with those at day 1 preoperatively（all P〈0.05）.No significant difference（all P〉0.05） was revealed in MMSE score and incidence of cognitive dysfunction among groups P,SP and S.Furthermore,MMSE score showed evidence of slight but statistically insignificant recovery（P〉0.05） at days 3 and 7 postoperatively.Conclusion General anesthesia may result in cognitive impairment in elderly patients postoperatively.Incidence of cognitive dysfunction,although various anaesthetic approaches are applied,may not differ significantly.

关 键 词：麻醉 全身 手术后并发症 认知障碍 老年人 

分 类 号：R614[医药卫生—麻醉学]