七氟醚和丙泊酚用于麻醉维持对患者脑氧代谢及认知功能的影响

摘要

Objective To compare of sevoflurane and propofol on cerebral oxygen metabolism and postoperative cognitive function during anesthesia maintenance.MethodsSeventy emergency trauma patients admitted to Zhoushan Hospital from August 2014 to August 2015, whom were randomLy divided into two groups (n=35 each): The control group anesthesia maintained by propofol;while the observation group were maintained with sevoflurane anesthesia.The changes of cerebral oxygen metabolism were compared between the two groups at different time points during anesthesia maintenance, and the Mini-Mental State Examination(MMSE) score, Trail-Making Test(TMT)completion time and the incidence of adverse reactions after recovery were also compared.ResultsThe SjvO2 values of each group were much higher in 2 min after induction (T2), 2 min after tracheal extubation (T3) than those before anesthesia (T1), while the Da-jvO2 and COER values were significantly decreased in T2 and T3 than those in T1, and the differences were statistically significant (P<0.05).These values were wihtout significant difference between the two groups in each period.The TMT completion time of the control group was prolonged than before induction, while the MMSE score was decreased than before induction, and the differences were statistically significant (P<0.05).There was no significant difference in TMT completion time and MMSE score in the observation group before and after induction.The incidence of adverse reactions between the two groups was not statistically significant.The eye opening time, orientation recovery time and anal exhaust time of control group were much later than those in observation group, and the differences were statistically significant (P<0.05).ConclusionSevoflurane and propofol can meet the need of maintaining the cerebral oxygen balance during anesthesia maintenance, but sevoflurane anesthesia has fewer influences in post-operation cognitive function.%目的 探讨七氟醚和丙泊酚用于麻醉维持对患者脑氧代谢及认知功能的影响.方法 选取2014年8月~2015年8月舟山医院收治的急症创伤患者70例,采用数字随机法将其分为对照组和观察组,每组35例.其中对照组术中麻醉维持采用丙泊酚;观察组术中麻醉维持采用七氟醚.比较2组在麻醉维持过程中不同时间点脑氧代谢变化情况;且对患者麻醉前后MMSE评分、TMT完成时间以及苏醒后不良反应发生率进行比较.结果 对照组与观察组在诱导后2min(T2),插管后2min(T3)SjvO2值较麻醉前(T1)明显升高,Da-jvO2与COER值则较T1时明显降低,且差异均具有统计学意义(P<0.05).2组在各时段组间差异无统计学意义.对照组术后TMT完成时间延长,MMSE评分降低,与术前相比差异具有统计学意义(P<0.05).观察组患者TMT完成时间以及MMSE评分手术前后无显著性差异.2组不良反应发生率差异不具有统计学意义.术后对照组患者呼唤睁眼时间,定向力恢复时间以及肛门排气时间均晚于观察组,且差异具有统计学意义(P<0.05).结论 七氟醚和丙泊酚均能维持手术期间脑氧供需平衡,七氟烷对患者术后认知功能改变的影响减少.