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目的观察全凭静脉麻醉和静吸复合麻醉对胃肠肿瘤患者全麻术后认知功能的影响。方法开腹胃肠肿瘤切除手术、麻醉时间超过3小时的患者25例,随机分为两组,全凭静脉麻醉组(TIVA组)12例,术中麻醉以丙泊酚+瑞芬太尼维持;静吸复合麻醉组(CIIA组)13例,术中麻醉以七氟烷+瑞芬太尼维持,其余麻醉处理相同。采用简易精神状态检查量表(MMSE)、连线测验量表(TMT)、简易视觉记忆量表(BVMT)、霍普金斯词语学习量表(HVLT)于术前1天、术后7天、术后30天对所有患者进行认知功能评分,并比较两组患者认知功能的差异。结果两组患者不同时间点MMSE、TMT及BVMT评分比较,差异无统计学意义(P>0.05);两组患者术后7天HVLT-T评分略有下降,术后30天逐渐恢复,差异有统计学意义(P<0.05);CIIA组患者术后7天HVLT-R评分下降较为明显(P<0.05),两组患者术后30天均能恢复至术前水平。结论持续吸入3小时以上七氟醚可降低患者术后短时间语言记忆能力,较长时间可恢复。
Objective To observe the effects of total intravenous anesthesia and static inhalation combined anesthesia on cognitive function after general anesthesia in patients with gastrointestinal tumors. Methods Twenty-five patients were randomly divided into two groups: TIVA group (n = 12) and propofol + remifentanil group (n = 12) ; Static inhalation combined anesthesia group (CIIA group) in 13 cases, intraoperative anesthesia with sevoflurane + remifentanil to maintain the rest of the same anesthesia. MMSE, TMT, BVMT and HVLT were measured at 1 day before surgery and 7 days after surgery All patients were scored for cognitive function 30 days after surgery and the differences of cognitive function between the two groups were compared. Results There was no significant difference in MMSE, TMT and BVMT scores between the two groups at different time points (P> 0.05). HVLT-T score decreased slightly on the 7th day and gradually recovered on the 30th day after operation (P <0.05). The HVLT-R score of CIIA group decreased significantly on the 7th day after operation (P <0.05). Both groups recovered to the preoperative levels 30 days after operation. CONCLUSION: Continuous inhalation of sevoflurane for more than three hours can reduce the short-term linguistic memory ability of patients after a long-term recovery.