七氟醚与丙泊酚静脉麻醉对老年髋关节置换术患者认知功能的影响(1)
摘 要：目的 比较七氟醚复合静脉麻醉与丙泊酚静脉麻醉对老年髋关节置换术患者认知功能的影响。方法 择期拟行髋关节置换术老年患者60例，采用随机数字表法分为七氟醚组和丙泊酚组，各30例，七氟醚组常规麻醉诱导后予2.5%～3.5%七氟醚，丙泊酚组常规麻醉诱导后予丙泊酚静脉靶控输注，分别于术前1 d 和术后7 d行镇静/警觉评分和简明精神状态量表评分评价患者认知功能。结果 丙泊酚组OAA/s评分(4.21±0.40)分，高于七氟醚组(3.98±0.35)分，差异有统计学意义(P<0.05)；术后7 d丙泊酚组MMSE评分、语言能力，高于七氟醚组，差异有统计学意义(P<0.05)，定向力、记忆力、注意力和计算力、回忆能力与七氟醚组，差异无统计学意义(P>0.05)。结论 丙泊酚静脉麻醉引起的术后认知功能损害低于七氟醚复合静脉麻醉，是老年患者更为理想的麻醉方案。
关键词：七氟醚；丙泊酚；镇静/警觉评分；简明精神状态量表；认知功能
中图分类号：R614 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.09.041
, 百拇医药
文章编号：1006-1959(2018)09-0133-03
Abstract：Objective To compare the effects of sevoflurane combined intravenous anesthesia and propofol intravenous anesthesia on cognitive function in elderly patients undergoing hip arthroplasty.Methods 60 elderly patients undergoing hip arthroplasty were randomly divided into sevoflurane group(n=30)and propofol group(n=30).The sevoflurane group received 2.5%～3.5% sevoflurane after induction of routine anesthesia.Propofol group was given target intravenous infusion of propofol after induction of routine anesthesia，The patientsundefined cognitive function was evaluated 1 d before operation and 7 d after operation by sedation/alertness scale and brief mental state scale.Results The OAA/s score of propofol group(4.21±0.40)was higher than that of sevoflurane group(3.98±0.35)，the difference was significant(P<0.05)，the MMSE score and language ability of the 7 d propofol group after operation were higher than those in the sevoflurane group，the difference was statistically significant(P<0.05).There was no significant difference in orientation， memory， attention，calculation and recall between sevoflurane group and sevoflurane group(P>0.05).Conclusion Propofol intravenous anesthesia induced postoperative cognitive impairment is lower than sevoflurane combined intravenous anesthesia，is an ideal anesthesia program for elderly patients.
, 百拇医药
Key words：Sevoflurane；Propofol；Sedation/Alertness score；Concise Mental State Scale；Cognitive function
术后认知功能障碍(postperative cognitive dysfunction，POCD)是临床上较为常见的麻醉并发症之一，研究显示，老年髋关节置换术后POCD的发生率达18.7%[1]，麻醉方式的选择可能是POCD的危险因素[2-4]。七氟醚与丙泊酚静脉麻醉是老年患者常用的麻醉方式，但其对老年患者术后认知功能的影响是否存在差异，尚需研究证实。本研究通过对比分析七氟醚与丙泊酚静脉麻醉对老年髋关节置换术患者认知功能的影响，旨在为老年患者麻醉方式的选择提供理论支持，现分析如下。
1资料与方法
1.1研究对象 选择择期行髋关节置换的60例老年患者為研究对象，本次研究经医院伦理委员会批准实施。纳入标准：①年龄65～80岁，性别不限，ASA麻醉评分I～II级；②所有患者对研究知情同意并签署知情同意书。排除标准：①近期服用精神类药物，既往有麻醉药物过敏史；②肝肾功能不全患者；③拒绝参加该实验的患者。采用随机数字表法将患者分为七氟醚组和丙泊酚组，每组30例。
1.2方法 术前常规禁饮食，入室后开放外周静脉通路，输注复方乳酸钠液500 ml，常规监测RR、HR、MAP、SpO2。麻醉诱导：静脉注射咪达唑仑0.05 mg/kg、芬太尼2～4 mg/kg、维库溴铵0.1 mg/kg和依托咪酯0.2～0.3 mg/kg，气管插管后行机械通气，呼吸参数：TV 5～7 ml/kg，通气频率10～13次/min，维持PETC0235～45 mm Hg。麻醉维持：七氟醚组持续吸入1%～3%七氟醚，丙泊酚组经静脉持续泵入丙泊酚10～20 μg/(kg·min)、间断静注咪达唑仑、芬太尼、维库溴铵。, 百拇医药(王丹 谢婷婷 张莉)
关键词：七氟醚；丙泊酚；镇静/警觉评分；简明精神状态量表；认知功能
中图分类号：R614 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.09.041
, 百拇医药
文章编号：1006-1959(2018)09-0133-03
Abstract：Objective To compare the effects of sevoflurane combined intravenous anesthesia and propofol intravenous anesthesia on cognitive function in elderly patients undergoing hip arthroplasty.Methods 60 elderly patients undergoing hip arthroplasty were randomly divided into sevoflurane group(n=30)and propofol group(n=30).The sevoflurane group received 2.5%～3.5% sevoflurane after induction of routine anesthesia.Propofol group was given target intravenous infusion of propofol after induction of routine anesthesia，The patientsundefined cognitive function was evaluated 1 d before operation and 7 d after operation by sedation/alertness scale and brief mental state scale.Results The OAA/s score of propofol group(4.21±0.40)was higher than that of sevoflurane group(3.98±0.35)，the difference was significant(P<0.05)，the MMSE score and language ability of the 7 d propofol group after operation were higher than those in the sevoflurane group，the difference was statistically significant(P<0.05).There was no significant difference in orientation， memory， attention，calculation and recall between sevoflurane group and sevoflurane group(P>0.05).Conclusion Propofol intravenous anesthesia induced postoperative cognitive impairment is lower than sevoflurane combined intravenous anesthesia，is an ideal anesthesia program for elderly patients.
, 百拇医药
Key words：Sevoflurane；Propofol；Sedation/Alertness score；Concise Mental State Scale；Cognitive function
术后认知功能障碍(postperative cognitive dysfunction，POCD)是临床上较为常见的麻醉并发症之一，研究显示，老年髋关节置换术后POCD的发生率达18.7%[1]，麻醉方式的选择可能是POCD的危险因素[2-4]。七氟醚与丙泊酚静脉麻醉是老年患者常用的麻醉方式，但其对老年患者术后认知功能的影响是否存在差异，尚需研究证实。本研究通过对比分析七氟醚与丙泊酚静脉麻醉对老年髋关节置换术患者认知功能的影响，旨在为老年患者麻醉方式的选择提供理论支持，现分析如下。
1资料与方法
1.1研究对象 选择择期行髋关节置换的60例老年患者為研究对象，本次研究经医院伦理委员会批准实施。纳入标准：①年龄65～80岁，性别不限，ASA麻醉评分I～II级；②所有患者对研究知情同意并签署知情同意书。排除标准：①近期服用精神类药物，既往有麻醉药物过敏史；②肝肾功能不全患者；③拒绝参加该实验的患者。采用随机数字表法将患者分为七氟醚组和丙泊酚组，每组30例。
1.2方法 术前常规禁饮食，入室后开放外周静脉通路，输注复方乳酸钠液500 ml，常规监测RR、HR、MAP、SpO2。麻醉诱导：静脉注射咪达唑仑0.05 mg/kg、芬太尼2～4 mg/kg、维库溴铵0.1 mg/kg和依托咪酯0.2～0.3 mg/kg，气管插管后行机械通气，呼吸参数：TV 5～7 ml/kg，通气频率10～13次/min，维持PETC0235～45 mm Hg。麻醉维持：七氟醚组持续吸入1%～3%七氟醚，丙泊酚组经静脉持续泵入丙泊酚10～20 μg/(kg·min)、间断静注咪达唑仑、芬太尼、维库溴铵。, 百拇医药(王丹 谢婷婷 张莉)