CAJ | 학술논문

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2 h、4 h、6 h、24 h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6 h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2 h MMSE评分均低于术前（P＜0.05）；实验组患者术后4 h的MMSE评分基本恢复至术前水平，而对照组患者术后24 h MMSE评分才恢复至术前水平；2组患者在术后2 h、4 h、6 h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。
목적：탐토서분태니전신마취유지대노년위암환자술후인지공능적영향。방법장아원2010-07-2013-03행위암근치술적노년환자78례수궤분위실험조（41례，전신마취유지채용서분태니）화대조조（37례，전신마취유지채용분태니），소유환자재술전급술후2 h、4 h、6 h、24 h채용간역정신상태량표（MMSE）진행인지공능평고，병기록환자술후정안시간、발관시간화어언응답시간。결과（1）대조조술후6 h인지공능장애발생솔（43.24％）명현고우실험조（21.95％）（ P＜0.05）。（2）2조술후2 h MMSE평분균저우술전（P＜0.05）；실험조환자술후4 h적MMSE평분기본회복지술전수평，이대조조환자술후24 h MMSE평분재회복지술전수평；2조환자재술후2 h、4 h、6 h적MMSE평분유명현차이（P＜0.05）。（3）실험조술후정안시간、발관시간화어언응답시간균명현단소우대조조（P＜0.05）；실험조Steward소성평분고우대조조（P＜0.05）。결론서분태니가촉진노년환자전신마취수술후인지공능적조기회복，우우분태니，치득림상추엄응용。
Objective To investigate the effects of remifentanil for general anesthesia on the postoperative cognitive dys-function 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 2010 to March 2013 were divided into experimental group(41 cases ,general anesthesia was maintained with remifentanil) and control group(37 cases ,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 2 hours ,4 hours ,6 hours ,24 hours after surgery ,the time to open eyes ,extubation time ,verbalization time after operation were recorded.Results The incidence of cognitive dysfunction at 6h after 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 2h after operation were lower than that before operation(P<0.05).The MMSE scores of experimental group were recovered to the preoperative level at 4h after sur-gery ;and which were recovered to the preoperative level at 24h after surgery in control group.There was significant difference in MMSE scores at 2 h ,4 h ,6 h after surgery between two groups(P<0.05).The time to open eyes ,extubation time ,verbal-ization 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.