上海交通大学学报（医学版）

›› 2011, Vol. 31 ›› Issue (3): 322-.doi: 10.3969/j.issn.1674-8115.2011.03.017

• 论著（临床研究） • 上一篇    下一篇

丙泊酚和七氟烷麻醉对老年患者普通胸外科手术后认知功能的影响

沈耀峰, 吴镜湘, 徐美英   

  1. 上海交通大学附属胸科医院麻醉科, 上海 200030
  • 出版日期:2011-03-28 发布日期:2011-03-29
  • 通讯作者: 徐美英, 电子信箱: myxu55@yahoo.com.cn。
  • 作者简介:沈耀峰(1974—), 男, 主治医师, 硕士；电子信箱: hydra-shen@hotmail.com。
  • 基金资助:

    上海市级医院适宜技术联合开发推广应用项目（SHDC12010222）

Effects of anesthesia with propofol and sevoflurane on postoperative cognitive function of elderly patients undergoing thoracic surgery

SHEN Yao-feng, WU Jing-xiang, XU Mei-ying   

  1. Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
  • Online:2011-03-28 Published:2011-03-29
  • Supported by:

    Shanghai Municipal Hospitals Joint Project, SHDC12010222

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摘要：

目的 探讨丙泊酚和七氟烷麻醉对老年患者普通胸外科手术后认知功能的影响。方法 普通胸外科择期手术的60例老年患者随机分为丙泊酚组（丙泊酚复合芬太尼全凭静脉麻醉）和七氟烷组（七氟烷复合芬太尼吸入麻醉），每组30例。记录两组患者的手术时间、单肺通气时间、术中失血量、术后睁眼时间和拔管时间等手术相关情况；采用简易智力状态检查表（MMSE）评估患者术前和术后1、3、6、24、72 h的认知功能；双抗体夹心ABCELISA法测定麻醉诱导前和术毕1 h血清S100β蛋白水平。结果 两组患者的手术时间、单肺通气时间和术中失血量比较差异无统计学意义（P>0.05）；七氟烷组术后睁眼时间和拔管时间显著长于丙泊酚组（P<0.05）。两组术前MMSE评分比较差异无统计学意义（P>0.05），术后1 h和3 h 的MMSE评分均显著低于术前（P<0.05）；七氟烷组术后1、3、6 h的MMSE评分显著低于丙泊酚组（P<0.05）；丙泊酚组和七氟烷组的MMSE评分分别于术后6 h和24 h 恢复至术前水平。两组术后血清S100β蛋白水平均显著高于麻醉诱导前（P<0.05），且七氟烷组显著高于丙泊酚组（P<0.05）。结论 丙泊酚和七氟烷麻醉均可引起老年患者普通胸外科手术后短期认知功能下降，使用丙泊酚麻醉者认知功能较早恢复至术前水平。

关键词: 丙泊酚, 七氟烷, 老年患者, 术后认知功能, 简易智力状态检查表

Abstract:

Objective To investigate the effects of anesthesia with propofol and sevoflurane on postoperative cognitive functions in elderly patients undergoing thoracic surgery. Methods Sixty elderly patients undergoing selective thoracic surgery were randomized into propofol group (anesthesia with propofol and fentanyl, n=30) and sevoflurane group (anesthesia with sevoflurane and fentanyl, n=30). The durations of operation and one-lung ventilation, volume of blood loss during operation and time of spontaneous eye opening and extubation were recorded. The cognitive function was assessed before operation and 1 h, 3 h, 6 h, 24 h and 72 h after operation by mini-mental state examination (MMSE), and the levels of serum S100β protein were detected before anesthesia and 1 h after operation by ABC-ELISA method. Results There was no significant difference in durations of operation and one-lung ventilation and volume of blood loss during operation between two groups (P>0.05). The time for spontaneous eye opening and extubation in sevoflurane group was significantly longer than that in propofol group (P<0.05). There was no significant difference in MMSE score between two groups before operation, while MMSE scores significantly decreased in both groups 1 h and 3 h after operation (P<0.05). MMSE scores in sevoflurane group were significantly lower than those in propofol group 1 h, 3 h and 6 h after operation （P<0.05）, and MMSE scores recovered to those before operation in propofol group and sevoflurane group 6 h and 24 h after operation, respectively. The levels of serum S100β protein after operation were significantly higher than those before operation in two groups（P<0.05）, and the level of serum S100β protein in sevoflurane group was significantly higher than that in propofol group after operation (P<0.05). Conclusion Anesthesia with propofol and sevoflurane may lead to short-term postoperative cognitive dysfunction in elderly patients undergoing thoracic surgery, and patients using propofol could recover from postoperative cognitive dysfunction faster.

Key words: propofol, sevoflurane, elderly patients, postoperative cognitive function, mini-mental state examination