【摘要】 目的探讨瑞芬太尼全身麻醉维持对老年胃癌患者术后认知功能的影响。方法将我院2010-07—2013-03行胃癌根治术的老年患者78例随机分为实验组(41例,全身麻醉维持采用瑞芬太尼)和对照组(37例,全身麻醉维持采用芬太尼),所有患者在术前及术后2h、4h、6h、24h采用简易精神状态量表(MMSE)进行认知功能评估,并记录患者术后睁眼时间、拔管时间和语言应答时间。结果 (1)对照组术后6h认知功能障碍发生率(43.24%)明显高于实验组(21.95%)(P<0.05)。(2)2组术后2hMMSE评分均低于术前(P<0.05);实验组患者术后4h的MMSE评分基本恢复至术前水平,而对照组患者术后24hMMSE评分才恢复至术前水平;2组患者在术后2h、4h、6h的MMSE评分有明显差异(P<0.05)。(3)实验组术后睁眼时间、拔管时间和语言应答时间均明显短少于对照组(P<0.05);实验组Steward苏醒评分高于对照组(P<0.05)。结论瑞芬太尼可促进老年患者全身麻醉手术后认知功能的早期恢复,优于芬太尼,值得临床推广应用。更多还原

【Abstract】 Objective To investigate the effects of remifentanil for general anesthesia on the postoperative cognitive dysfunction in elderly patients with gastric cancer.Methods Seventy-eight cases of elderly patients with gastric cancer scheduled for radical gastrectomy in our hospital from July 2010to March 2013were divided into experimental group(41cases,general anesthesia was maintained with remifentanil)and control group(37cases,general anesthesia was maintained with fentanyl),the cognitive function of all patients was assessed by the Mini-Mental State Examination(MMSE)at four time points:baseline and 2hours,4hours,6hours,24hours after surgery,the time to open eyes,extubation time,verbalization time after operation were recorded.Results The incidence of cognitive dysfunction at 6hafter operation of control group(43.24%)was higher than that of experimental group(21.95%)(P<0.05).The MMSE scores of two groups at 2hafter operation were lower than that before operation(P<0.05).The MMSE scores of experimental group were recovered to the preoperative level at 4hafter surgery;and which were recovered to the preoperative level at 24hafter surgery in control group.There was significant difference in MMSE scores at 2h,4h,6hafter surgery between two groups(P<0.05).The time to open eyes,extubation time,verbalization time after operation in experimental group were less than that in control group(P<0.05).The scores of Steward was higher in experimental group than that in control group(P<0.05).Conclusion Remifentanil for general anesthesia can promote the early recovery of cognitive dysfunction in elderly patients after radical gastrectomy,it is better than fentanyl,and is worthy of widely clinical advocation.更多还原