药物与临床
FENG Li;TIAN Yu-ke;WANG Peng;CHEN Ming-bing
Objective To compare the effects of three general anesthesia Methods including intravenous compound anesthesia with midazolam, propofol or two drugs combined with inhalation of isoflurane on postoperative cognitive function of elderly patients. Methods 45 ASA Ⅰ-Ⅱ patients aged 60-80 years undergoing laparoscopic operation were randomly assigned on three groups: group A(n=15), midazolam was injected intravenously for anesthesia induction and midazolaminfusion was used in anesthesia maintenance; group B(n=15), propofol was given in anesthesia induction and propofolinfusion was used during surgery for anesthesia maintenance; group C(n=15), midazolam and propofol were given for anesthesia induction and during operation, and isoflurane was inhaled for anesthesia maintenance. The vital signs and AAI were monitored. The cognitive function tests were performed before surgery and at early recovery, medium recovery and late recovery after awakening. Results Early recovery: 5 min after awakening, the scores of patients in group A were significantly lower than values of preoperative, group B and group C (P<0.05). But 15 min after awakening, group A returned to preoperative level. And there was no significant difference between other two groups at every time points (5,15,30 min)( P>0.05). Medium recovery: 30 min after awakening, the scores decreased significantly in patients in three groups compared with preoperative values(P<0.05). Group A scored lowest(P<0.05) and group B, group C by turns(P<0.05); 1 h after awakening, the scores of group A and group B increased significantly and there was significantly difference between them(P<0.05), but they were all lower than preoperative values(P<0.05), at this time the scores of patients in group C returned to preoperative level. And so did group B at 2 h, yet the cognitive function level of group A was still lower than preoperative values(P<0.05). Late recovery: 4 h after awakening, the scores of patients in group A and group B were both lower than preoperative values(P<0.05). Group A scored lower(P<0.05) and there was no significant difference between the scores of group C and preoperative values(P>0.05). 24 h after awakening, the scores of group B returned to preoperative level(P>0.05), but the cognitive function of group A had not recovered(P<0.05). 72 h after awakening, the cognitive function level of group A descent significantly(P<0.05), and there was no significantly difference in other two groups compared with preoperative values(P>0.05).Conclusion The three Methods of general anesthesia have some influence on the cognitive function of elderly patients three days after surgery. The total effect of midazolambased anesthesia is most serious and lasts longer, and the influence of propofolbased anesthesia is much slighter. Yet the cognitive function of patients treated with midazolam and propofol intravenous combined with inhalation of isoflurane anesthesia is recovered the quickest.