七氟醚复合丙泊酚静吸复合麻醉对老年食管癌患者术后早期认知功能的影响被引量：42

The study of the effect of sevoflurane inhalation combined with intravenous propofol anesthesia and propofol TIVA on postoperative cognitive function in senile patients with esophageal cancer

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摘要目的观察七氟醚复合丙泊酚静吸复合麻醉对老年食管癌患者术后早期认知功能的影响。方法择期食管癌根治术老年患者30例，ASAⅠ～Ⅲ级，年龄60-75周岁，随机均分为七氟醚复合丙泊酚麻醉组（S组）和丙泊酚全凭静脉组（P组）。分别于手术前1天、术后第3天和第7天测定简易精神状态量表（MMSE）评分，并分别于麻醉前、术毕和术后第3天检测血清S100β和血清神经元特异性烯醇化酶（NSE）的含量。结果与手术前1d比较，两组患者术后第3天MMSE评分均降低（P〈0．05），但组间差异无统计学意义，术后第7天恢复正常。S组术后出现轻度认知功能障碍的患者为4例（27％），P组为2例（13％）。与麻醉前相比，两组患者术毕及术后第3天NSE的含量显著增高（P〈0．05），但组间差异无统计学意义。结论与丙泊酚全凭静脉麻醉相比，七氟醚复合丙泊酚静吸复合麻醉并不增加术后早期认知功能障碍的发生率。 Objective To compare the effect of sevoflurane inhalation combined with intravenous propofol anesthesia and propofol total intravenous anesthesia（TIVA） on postoperative cognitive function in senile patients with esophageal cancer. Methods Thirty ASA Ⅰ～Ⅲ patients aged 60-75y for selective esophagus cancer radical operation were randomly assigned to 2 groups. In group S, patients received sevoflurane combined with intravenous propofol anesthesia whereas group P patients were subjected to propofol TIVA during the period of general anesthesia maintenance. In either group,Mini-mental state examination （MMSE） scores were measured at day 1 prior to surgery as well as postoperative day 3 and 7 whereas serum S100β and serum neuron specific enolase （NSE） were assayed respectively at time points listed as follows： before anesthesia, when the surgical procedure was over and at postoperative day 3. Results Compared with pre-anesthesia condition, MMSE at day 3 following surgery attenuated notably in both groups （P〈0.05） whereas no statistical significance was recorded between group S and P. At postoperative day 7, MMSE returned to normal. However, compared with pre-anesthesia condition, notable elevation in NSE was recorded at the end of surgery as well as postoperative day 3 （P〈 0.05）, yet no marked difference emerged between 2 groups. Interestingly, serum S100β under postanesthesia circumstances displayed no significant elevation. In addition, mild cognitive dysfunction was observed in 4 patients, covering a percentage of 27% in group A whereas the ratio in group P was 13%. Conclusion Compared with TIVA, sevoflurane inhalation combined with intravenous anesthesia may not increase the rate of postsurgical cognitive dysfunction occurrence.

作者刘伟饶丽华郭淑静陈斌马正良

机构地区南京大学医学院附属鼓楼医院集团宿迁市人民医院麻醉科南京大学医学院附属鼓楼医院麻醉科

出处《临床麻醉学杂志》 CAS CSCD 北大核心 2011年第4期373-375,共3页 Journal of Clinical Anesthesiology

关键词老年术后认知功能障碍七氟醚丙泊酚简易精神状态量表 Elderly Postoperative cognitive dysfunction Sevoflurane Propofol Minimental state examination

分类号 R614 [医药卫生—麻醉学]

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参考文献9

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