快速康复外科理念结合七氟醚、异丙酚全麻对老年乳腺癌术后苏醒时间及认知功能的影响  

Effect of sevoflurane and propofol general anesthesia on recovery time and postoperative cognitive function in elderly patients with breast cancer after FTS

作　　者：窦田友 霍焱 李君辉 DOU Tianyou;HUO Yan;LI Junhui(Department of Undergraduates;Department of Nursing;Department of Oncology,Tangshan Third Hospital,Tangshan 066100,China)

机构地区：[1]河北省唐山市第三医院麻醉科,063100 [2]河北省唐山市第三医院护理部,063100 [3]河北省唐山市第三医院肿瘤科,063100

出　　处：《武警医学》2018年第8期766-769,共4页Medical Journal of the Chinese People's Armed Police Force

基　　金：河北省医学科学研究重点课题计划(20160818)

摘　　要：目的探讨快速康复外科理念(fast track surgery,FTS)结合七氟醚、异丙酚全麻对老年乳腺癌术后苏醒时间及认知功能的影响。方法选择我院收治的62例老年乳腺癌患者,随机分为七氟醚组和丙泊酚组(每组31例)。术前麻醉中,两组患者均行依托咪酯、芬太尼、维库溴铵、咪达唑仑诱导麻醉,其中七氟醚组患者予以七氟醚维持麻醉,丙泊酚组患者予以异丙酚维持麻醉。评价两组患者的麻醉效果;统计患者恢复自主呼吸时间、睁眼时间、定向力恢复时间及Aldrete评分;同时采用简易智能精神状态评分(MMSE评分)评估患者术后认知功能障碍的发生率。结果观察组和对照组麻醉效果优良率均为100%。平均恢复自主呼吸时间、睁眼时间、定向力恢复时间指标值的比较上,丙泊酚组均短于七氟醚组(P<0.05);在平均Aldrete评分指标值的比较上,七氟醚组低于丙泊酚组(P<0.05)。术后2 h,两组患者平均MMSE评分较麻醉前均降低(P<0.05),七氟醚组患者认知功能障碍发生率为38.71%,丙泊酚组为19.35%,七氟醚组高于丙泊酚组(P<0.05);术后12 h,七氟醚组患者认知功能障碍发生率为22.58%,丙泊酚组为9.68%,七氟醚组高于丙泊酚组(P<0.05)。结论七氟醚、异丙酚全麻在老年乳腺癌患者麻醉中能取得相当的麻醉效果,但FTS理念下异丙酚麻醉患者的苏醒质量优于七氟醚,且能减少术后认知功能障碍的发生率,康复效果更好。Objective To compare the effects of sevoflurane and propofol general anesthesia on recovery time and postoperative cognitive function in elderly patients with breast cancer after FTS. Methods Sixty-two elderly patients with breast cancer treated in our hospital were randomly divided into the sevoflurane group and propofol group（ n = 31）. The two groups were anesthetized with etomidate,fentanyl,vecuronium,and midazolam. Anesthesia was maintained with sevoflurane in the sevoflurane group,but with propofol in the propofol group. The anesthetic effect of the two groups was evaluated. The time the patients recovered spontaneous breathing,the time they opened their eyes,the time they resumed their sense of orientation and the Aldrete score were statistically analyzed. The incidence of cognitive impairment after operation was evaluated by a simple intelligent mental state score（ MMSE score）. Results The excellent and good rate of anesthetic effect was 100% in both groups. There was no significant difference between the two groups. The propofol group took less time to recover their spontaneous breathing,to resume their ability to open their eyes and tell the direction than the sevoflurane group（ P〈0. 05）,but the average Aldrete score of the sevoflurane group was lower than that of the propofol group（ P〈0. 05）. 2 h after operation,the average MMSE score in the two groups became lower（ P〈0. 05）. The incidence of cognitive dysfunction was 38. 71% in the sevoflurane group,compared with 19. 35% in the propofol group. The rate of cognitive dysfunction was22. 58% in the postoperative 12 h in the sevoflurane group,but was 9. 68% in the propofol group. Conclusions Both sevoflurane and propofol can be used for effective anesthesia in elderly patients with breast cancer,but propofol is more effective for the recovery of consciousness under the concept of FTS by reducing the incidence of cognitive impairment after operation and contributing to rehabilitation.

关 键 词：快速康复外科理念 乳腺癌 老年 麻醉 七氟醚 异丙酚 

分 类 号：R614.2[医药卫生—麻醉学]