徐建立

[摘要]目的 探討瑞芬太尼和异丙酚全凭静脉麻醉对老年腹腔镜下胆囊切除术后认知功能的影响。方法 选取本院2015年6月～2016年12月收治的84例进行腹腔镜下胆囊切除术的老年患者，随机分成两组，各42例。其中对照组患者采用七氟醚静吸复合麻醉，实验组患者采用瑞芬太尼和异丙酚全凭静脉麻醉，观察两组患者的麻醉效果及对认知功能的影响。结果 手术后，两组患者的手术时间、拔管时间差异无统计学意义（P>0.05），实验组的苏醒时间、自主恢复呼吸时间和定向力恢复时间均显著短于对照组（P<0.05）；除了拔管24 h后两组患者意识状态差异无统计学意义（P>0.05）外，其余时间段实验组患者的意识状态均显著优于对照组（P<0.05）；除了术前24 h和拔管24 h后两组患者认知功能差异无统计学意义（P>0.05）外，其余时间段实验组患者的认知功能均显著优于对照组（P<0.05）。结论 瑞芬太尼和异丙酚全凭静脉麻醉应用于老年腹腔镜下胆囊切除术后可提高患者术中生命体征平稳程度，有效减轻患者的应激反应，且能达到显著的认知功能恢复效果，值得临床广泛推广。

[关键词]瑞芬太尼；异丙酚；全凭静脉麻醉；胆囊切除术

[中图分类号] R614.2+4 [文献标识码] A [文章编号] 1674-4721（2017）05（b）-0103-03

Influence of Remifentanil and Propofol for total intravenous anesthesia on cognitive function in elderly patients undergoing laparoscopic cholecystectomy

XU Jian-li

Department of Anesthesiology，the Third People′s Hospital of Longgang District in Shenzhen City of Guangdong Province，Shenzhen 518115，China

[Abstract]Objective To explore the influence of Remifentanil and Propofol for total intravenous anesthesia on cognitive function in elderly patients undergoing laparoscopic cholecystectomy.Methods 84 elderly patients given laparoscopic cholecystectomy in our hospital from June 2015 to December 2016 were selected and randomly divided into two groups，and there were 42 cases in each group.The control group was given Sevoflurane for balance anesthesia，while the experimental group was given Remifentanil and Propofol for total intravenous anesthesia.The anesthetic effect and its influence on cognitive function of the two groups were observed.Results After operation，the operation time，extubation time between two groups had no statistical difference （P>0.05），while the recovery time，spontaneous breathing and the recovery time of directive force in the experimental group were significantly shorter than those of the control group （P<0.05）.In addition to there was no statistical difference （P>0.05） of conscious state 24 hours after extubation，then at other time slot，the conscious state in the experimental group were significantly better than those of the control group （P<0.05）.In addition there was no significant difference （P>0.05） between the cognitive function of two groups of patients before 24 hours and 24 hours after extubation （P>0.05），and at other time slot，cognitive function in the experimental group were significantly better than those of the control group （P<0.05）.Conclusion Remifentanil and Propofol for total intravenous anesthesia applied in elderly patients undergoing laparoscopic cholecystectomy can increase the stable degree of vital signs during operation and effectively reduce the stress of patients，and can achieve significant effect on the recovery of cognitive function，and it is worthy of clinical wide promotion.

[Key words]Remifentanil；Propofol；Total intravenous anesthesia；Cholecystectomy

随着医学领域的发展，微创手术也在不断的进步，患者对麻醉效果的要求逐渐变高，如在进行腹腔镜胆囊切除术时需要麻醉起效快且苏醒块等要求。但麻醉后患者常常会发生术后认知功能障碍（POCD），这一现象正处于日趋严重的趋势[1]。该症状主要变现为记忆受损、焦虑、思维混乱、注意力不集中、自制力较差、人格分裂、社交能力受损等精神症状。该病症多数发生在老年患者中，其原因有可能是因为老年患者的全身器官功能已衰退，不能及时代谢和清除体内残留的麻醉药物，因此会更容易产生认知功能障碍[2-3]，因此，寻找一种具有起效快、可控性高、术后苏醒快、体内无蓄积等优点的麻醉方法已成为本领域的研究热点[4]。本……