七氟醚静吸复合麻醉对老年患者术后早期认知功能的影响

摘要

Objective To investigate the effects of sevoflurane combined anesthesia on the early cognitive function of the elderly patients.Methods 120 patients underwent laparoscopic surgery in our hospital from August 2014 to August 2016 were selected and randomly divided into two groups:sevoflurane group 60 cases, sevoflurane anesthesia during operation and propofol anesthesia 60 cases, propofol anesthesia during operation.MMSE was used to detect the cognitive function at one day before operation, one day, three days and seven days after surgery respectively.The blood samples were taken from the patients of the two groups at the time of one day before operation, one hour after operation and one day after operation, the levels of serum TNF-αand IL-6 were measured by enzyme-linked immunosorbent assay ( ELISA ) . The recovery time and adverse reactions were observed after operation.Results The average recovery time was (18.94 ±3.32) min in the propofol group and (10.62 ±2.31) min in the sevoflurane group, the sevoflurane group was better than the propofol group, the difference was statistically significant (P<0.05).The scores of MMSE were significantly lower in the sevoflurane group one day after operation than those in the one day before operation, the difference was statistically significant (P<0.05).The scores returned to the preoperative level three days and seven days after operation.In the propofol group, the MMSE score was significantly lower at one day after operation than that before operation, the difference was statistically significant (P<0.05), but increased three days after operation but did not reach the preoperative level, and sevoflurane group, the difference was statistically significant.After treatment, the levels of TNF-and IL-6 in serum of two groups increased, the level of TNF-αand IL-6 in the propofol group one hour after operation and one day after operation were significantly higher than those in the sevoflurane group, the difference between the two groups was statistically significant ( P <0.05 ).Conclusion The sevoflurane compound anesthesia in patients after surgery, the recovery of cognitive ability faster, fewer side effects in patients.%目的 研究七氟醚静吸复合麻醉对老年患者术后早期认知功能影响.方法 选取2014年8月~2016年8月于厦门大学附属第一医院和福建医科大学附属第一医院进行腹腔镜手术的患者120例,将患者随机分为2组:七氟醚组60例,手术中使用七氟醚麻醉;丙泊酚组60例,手术中使用丙泊酚麻醉.使用简易智能状态量表(minimental state examination MMSE)在患者手术前1 d、手术后1、3、7d时进行认知功能的检测;在手术前1d、手术后1h和手术后1d分别取2组患者静脉血5mL,使用酶联免疫吸附发来检测患者血清肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)与白细胞介素-6(interleukin-6,IL-6)的水平情况;观察患者手术后的苏醒时间和发生不良反应情况.结果 丙泊酚组患者平均苏醒时间(18.94±3.32)min,七氟醚组患者平均苏醒时间(10.62±2.31)min,七氟醚组优于丙泊酚组,2组对比差异有统计学意义(P<0.05);七氟醚组患者手术后1d MMSE评分比手术前1 d明显降低,差异有统计学意义(P<0.05),手术后3 d和7 d其评分恢复至手术前水平;丙泊酚组患者手术后1d MMSE评分比手术前1 d明显降低,差异有统计学意义(P<0.05),手术后3 d虽有上升但仍未到达手术前水平,和七氟醚组对比差异有统计学意义;治疗后2组患者血清中TNF-α与IL-6含量均有不同程度的升高,丙泊酚组患者手术后1h和手术后1d TNF-α与IL-6升高比七氟醚组更多,2组对比差异有统计学意义(P<0.05).结论 使用七氟醚静吸复合麻醉的患者手术后其认知能力恢复的较快,对患者不良反应少.