吸入、静脉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  

The effect of intravenous general anesthesia or inhalation general anesthesia on postoperative cognitive dysfunction(POCD)and resuscitation quality in elderly patients undergoing surgery

作　　者：彭五一[1] 王志涛[1] 刘德君[1] 董铁立[1] PENG Wuyi;WANGZhitao;LIU Dejun(Department of Anesthesiology,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450002,China)

机构地区：[1]河南省郑州大学第二附属医院麻醉科,郑州450002

出　　处：《国际精神病学杂志》2020年第3期576-579,共4页Journal Of International Psychiatry

摘　　要：目的探讨老年手术患者接受静脉全麻、吸入全麻对术后认知功能障碍(POCD)与复苏造成的影响。方法将2017年5月~2019年5月期间的老年手术患者88例随机分为对照组(七氟醚全凭吸入麻醉)与观察组(异丙酚全凭静脉维持麻醉),各44例,对比两组麻醉效果和认知功能。结果(1)观察组拔管时间、苏醒时间均短于对照组,躁动发生率低于对照组(P<0.05)。(2)两组T0、T1、T2、T3血浆白介素-6(IL-6)水平无明显区别(P>0.05);两组T0、T3时刻S100β水平无明显差别(P>0.05);观察组T1、T2时期100β水平低于对照组(P<0.05)。(3)两组同期简明精神状态检查量表(MMSE)评分和POCD发生率对没有明显区别(P>0.05);(4)观察组低血压、恶心呕吐发生率低于对照组,心动过缓发生率高于对照组(P<0.05);两组镇痛不全发生率无明显区别(P>0.05)。结论静脉麻醉可以缩短苏醒时间与拔管时间,减少术中低血压、术后恶心呕吐和拔管期躁动的发生,有利于术后苏醒,但是静脉麻醉更容易造成心动过缓,慢性心律失常患者需谨慎使用。Objective To investigate the effects of intravenous general anesthesia and inhalation general anesthesia on postoperative cognitive dysfunction(POCD)and resuscitation quality in elderly patients undergoing surgery.Methods From May 2017 to May 2019,88 elderly surgical patients were randomly divided into the control group(sevoflurane anesthesia by inhalation)and the observation group(propofol anesthesia by intravenous maintenance),with 44 cases each.The postoperative cognitive dysfunction(POCD)and resuscitation quality of two groups were compared.Results(1)The extubation time and wake time in the observation group were shorter than those in the control group,and the incidence of agitation was lower than that in the control group(P<0.05).(2)Plasma interleukin-6(il-6)levels of T0,T1,T2 and T3 in the two groups were no difference(P>0.05).The S100 beta level at T0 and T3 between the two groups were no difference(P>0.05)(.3)The brief mental state examination scale(MMSE)scores and POCD incidence of the two groups were no difference(P>0.05).(4)The incidence of hypotension,nausea and vomiting in the observation group was lower than that in the control group(P<0.05).The incidence of bradycardia in the observation group was higher than that in the control group(P<0.05).The incidence of analgesia insufficiency between the two groups was no difference(P>0.05).Conclusion The intravenous anesthesia shorten the awaken time and extubation time,less intraoperative hypotension and extubation period of agitation,conducive to the postoperative revival,can reduce postoperative nausea and vomiting,but it's easier to cause bradycardia,intravenous anesthesia chronic arrhythmia patients need to be careful to use.

关 键 词：老年手术患者 麻醉方式 POCD 复苏质量 

分 类 号：R749.99[医药卫生—神经病学与精神病学]