不同全身麻醉方式对老年人术后认知功能障碍及复苏质量的影响  

Effects of Different General Anesthesia Methods on Postoperative Cognitive Dysfunction and Recovery Quality in Elderly Patients

作　　者：罗耀文[1] 徐明禹 董心童[1] 袁瑞霞[1] 詹美俊[1] 张雪萍[1] 

机构地区：[1]暨南大学第二临床医学院附属深圳市人民医院.广东省深圳市麻醉医学工程研究中心,广东深圳518020

出　　处：《中国药业》2017年第16期32-35,共4页China Pharmaceuticals

基　　金：广东省深圳市科技计划项目[JCYJ20140416122812032]

摘　　要：目的比较不同全身麻醉(简称全麻)方式对老年人术后认知功能障碍(POCD)及复苏质量的影响。方法选取老年患者84例,随机分为P组,S组及C组。所有患者常规静脉诱导后插管,P组,S组,C组分别采用异丙酚、七氟烷、异丙酚复合七氟烷维持麻醉,同时静脉泵注射瑞芬太尼。记录拔管时间、苏醒时间、躁动发生率,测定手术前1天(T_0)、手术结束时(T_1)、术后第1天(T_2)和术后第3天(T_3)患者静脉血中白细胞介素6(IL-6)、S100β浓度,观察T_0,T_2,T_3时点简易精神状态检查量表(MMSE)评分和POCD的发生情况,记录术中低血压、心动过缓和术后低氧血症、镇痛不全、恶心呕吐的发生情况。结果与P组和C组比较,S组拔管时间和苏醒时间长(P<0.05),躁动发生率高(P<0.05);T_2时点,S组S100β浓度高于P组和C组(P<0.05),P组和C组T_1时点S100β浓度高于T_0,T_2,T_3时点(P<0.05),S组T_1和T_2时点S100β浓度高于T_0,T_3时点(P<0.05);3组MMSE评分和POCD发生率比较,差异无统计学意义(P>0.05);S组低血压发生率高于P组和C组(P<0.05),与S组和C组比较,P组心动过缓发生率更高(P<0.05),恶心呕吐发生率更低(P<0.05)。结论全麻后恢复快,中枢神经系统细胞的损伤持续时间短、并发症少,是较适合老年患者手术的麻醉方式。Objective To compare the effect of different general anesthesia methods on postoperative cognitive dysfunction and recovery quality in elderly patients. Methods Totally 84 elderly patients were randomly divided into group P,group S and group C. After conventional intravenous induction,anesthesia was maintained by propofol,sevoflurane,propofol combined with sevoflurane in group P,group S and group C,respectively,while intravenous injection of remifentanil. The extubation time,recovery time,the incidence of agitation were observed. The plasma concentrations of IL-6 and S100β were determined 1 d before operation（ T_0）,at the end of the operation（ T_1）,on the first day after operation（ T_2）,on the third day after operation（ T_3）. Postoperative cognitive dysfunction was assessed by min-mental state examination（ MMSE） at T_0,T_2,T_3. The incidence of hypotension and bradycardia during operation and the incidence of hypoxemia,analgesia,nausea and vomiting after operation were recorded. Results Compared with group P and group C,the extubation time and recovery time were longer and the incidence of agitation was higher in group S（ P 0. 05）. The level of S100β was higher in group S than those in group P and group C at T_2（ P 0. 05）. The level of S100 β was highest at T_1 in group P and group C at T_1（ P 0. 05）,while the levels of S100β was higher at T_1 and T_2 than those at T_3 and T_4 in group S（ P 0. 05）. There was no significant difference among the three groups in the MMSE score and the incidence of POCD（ P 0. 05）. The incidence of hypotension was highest in group S（ P 0. 05）. Compared with group S and group C,the incidence of bradycardia was higher but the incidence of nausea and vomiting was lower in group P（ P 0. 05）. Conclusion General anesthesia is a suitable anesthesia method for elderly patients,which has the advantages of quick recovery,short duration of central nervous system damage and less complications.

关 键 词：静脉麻醉 吸入麻醉 静吸复合麻醉 术后认知功能障碍 复苏质量 老年 

分 类 号：R969.4[医药卫生—药理学] R971.2[医药卫生—药学]