地氟烷、七氟烷和异丙酚用于老年患者前列腺 电切术苏醒时间及术后认知功能的比较

Comparison of awakening time and postoperative cognitive function among Desflurane, Sevoflurane and Diprivan used in electro-prostatectomy in senile patients

摘要:

目的 比较地氟烷、七氟烷和异丙酚用于老年患者前列腺电切术苏醒时间及对术后认知功能的 影响。方法 180 例择期行前列腺术的患者，年龄均在65 岁以上。静脉中长链丙泊酚TCI 诱导、注射舒芬太 尼、順式阿曲库铵快诱导插入喉罩后随机分为地氟烷组（D1 组）、七氟烷组（D2 组）和异丙酚组（D3 组）。 麻醉诱导前及手术后1、2、3 及12 h 应用简易精神状态检查表（MMSE）的测定方法评定患者的认知功能； 记录麻醉时间、手术时间、从停药到熵指数达到90 的时间和睁眼时间、拔喉罩时间；记录寒颤、恶心呕吐、 躁动等不良反应发生情况。结果 3 组患者的麻醉时间、手术时间、不良反应比较差异无统计学意义（P >0.05）； D1 组停药到熵指数达到90 和睁眼时间、拔喉罩时间与D2、D3 组比较，差异有统计学意义（P <0.05），D1 组小于D2、D3 组；术后1、2 h D1 组术后恢复正常认知功能时间较D2、D3 组时间短，差异有统计学意义 （P <0.05），术后3 和12 h 的认知功能比较，差异无统计学意义（P >0.05）。结论 老年患者前列腺电切术应用 地氟烷的短期恢复时间短于七氟烷和异丙酚，有利于患者的快速康复，值得进一步推广。

Abstract:

Objective To compare the effect of Desflurane, Sevoflurane and Diprivan used in electroprostatectomy in senile patients. Methods According to plan, 180 patients over 65 years had operations on their prostates. After induction of TCI by intravenous long chain Propofol, injection of Sufentanil, fast induction of Cisatracurium and insertion of laryngeal mask, they were divided into Desflurane group (group D1), Sevoflurane group (group D2) and Diprivan group (group D3). Mini-Mental State Examination (MMSE) was used to assess the cognitive function of the patients before anesthesia induction and in 1, 2, 3 and 12 h after operation. The time of anesthesia, the operation time, the time from drug withdrawal to the entropy index to 90, the wake-up time and the time of pulling out laryngeal mask were recorded. Shivering, nausea and vomiting, restlessness and other adverse reactions were recorded. Results There was no significant difference in the time of anesthesia, the time of operation or the incidence of adverse reactions among the three groups (P > 0.05). The time from drug withdrawal to the entropy index to 90, the wake-up time and the time of pulling out laryngeal mask in the group D1 were shorter than those in the groups D2 and D3 (P < 0.05). The time of regaining normal cognitive function in the group D1 was significantly shorter than that in the groups D2 and D3 in 1 and 2 h after surgery (P < 0.05). The cognitive function was not significantly different among the three groups in 3 and 12 h after operation (P > 0.05). Conclusions In electro-prostatectomy for senile patients, the time of regaining consciousness of Desflurane is shorter than that of Sevoflurane or Diprivan, which is benefit to quick rehabilitation of the patients. And it is worthy of further promotion.