不同全身麻醉方式对老年消化道肿瘤患者手术后早期认知功能的影响

摘要

目的 比较不同全身麻醉方式对老年患者消化道肿瘤手术后早期认知功能的影响.方法 随机选择90例无神经精神系统疾病史或服用相应药物的消化道肿瘤患者,美国麻醉医师协会(ASA)Ⅰ～Ⅱ级,年龄60～79岁,采用随机数字表法,将择期行消化道肿瘤手术患者随机分为3组(每组30例):异丙酚全凭静脉组(P组)、七氟醚与异丙酚静吸复合组(SP组)、七氟醚吸入麻醉组(S组).分别于术前1 d、出麻醉恢复室时及术后1、3、7 d时,采用简易精神状态评价量表(MMSE)进行认知功能评分.结果 与术前1 d比较,P组、SP组、S组出麻醉恢复室时、术后1 d时MMSE评分降低(P＜0.05),出麻醉恢复室时、术后1 d时认知功能障碍发生率升高(P＜0.05);术后3、7 d 时MMSE评分有所恢复,虽较术前略下降,但差异无统计学意义(P＞0.05);P组、SP组、S组间MMSE评分和术后认知功能障碍发生率差异无统计学意义.结论 老年患者全身麻醉术后早期认知功能下降,不同全身麻醉方式早期认知功能障碍发生率差异无统计学意义.%Objective To compare the impact of various anesthetic approaches on early cognition in elderly patients who underwent gastrointestinal cancer surgery. Methods Ninety patients (ASA I - II) who were scheduled for elective gastrointestinal cancer surgery, aged 60-79 years and have neither history of neurological or psychiatric disease nor on anti-tumor medication were randomly assigned into group P (n=30) to receive propofol intravenous injection, group SP (n=30) to be treated with sevoflurane and propofol inhalation, group S (n=30) to undergo sevoflurane anesthesia, on the basis of random number table. Cognition was assessed using IV1MSE scale at day 1 preoperatively, during the stay in anesthesia recovery room and at days 1., 3 and 7 postoperative!}', respectively. Results Groups S, P and SP yielded reduced IV1MSE score and higher incidence of cognitive dysfunction during the stay in anesthesia recovery room and at day 1 postoperative!}' as compared with those at. day 1 preoperatively (all P＜0.05}. No significant difference (all P＞0.05) was revealed in MMSE score and incidence of cognitive dysfunction among groups P, SP and S. furthermore, IV1MSE score showed evidence of slight but statistical!}' insignificant recover (P＜0.05) at days 3 and 7 postoperatively. Conclusion General anesthesia may result in cognitive impairment in elderly patients postoperatively. Incidence of cognitive dysfunction, although various anaesthetic approaches are applied, may not differ significantly.