CAJ | 학술논문

目的：探讨七氟烷吸入麻醉对老年非小细胞肺癌患者术后认知功能和苏醒质量的影响。方法90例择期行肺癌根治术患者随机分为观察组、对照组和联合给药组。观察组给予七氟烷吸入麻醉维持，对照组给予丙泊酚泵注麻醉维持，联合给药组给予七氟烷和丙泊酚泵注麻醉，三组其它麻醉方案相同。采用简易智能精神状态评分( MMSE)分别于术前，术后6 h、术后1、3、5、7 d对患者进行认知功能进行评价，观察患者睁眼时间，拔管时间，定向力恢复时间。结果两组术后6 h、术后1、3、5、7 d时的MMSE评分表现出先降后升的趋势，且观察组术后6 h、术后1、3、5、7 d时的MMSE评分与术前和对照组比较有均有显著性差异( P<0．05或P<0．01)。观察组POCD发生率为10．0%，对照组为26．7%，观察组与对照组相比较有显著性差异(P<0．01)。联合组发生率为16．7%，与对照组相比，具有显著性差异(P<0．01)。观察组和联合组定向力恢复时间、拔管时间均低于对照组，相比较有显著性差异( P<0．05)。结论七氟醚吸入麻醉对老年非小细胞肺癌患者术后认知功能影响小，患者术后苏醒质量较高，是老年非小细胞肺癌患者理想的麻醉维持方法，值得临床应用。
목적：탐토칠불완흡입마취대노년비소세포폐암환자술후인지공능화소성질량적영향。방법90례택기행폐암근치술환자수궤분위관찰조、대조조화연합급약조。관찰조급여칠불완흡입마취유지，대조조급여병박분빙주마취유지，연합급약조급여칠불완화병박분빙주마취，삼조기타마취방안상동。채용간역지능정신상태평분( MMSE)분별우술전，술후6 h、술후1、3、5、7 d대환자진행인지공능진행평개，관찰환자정안시간，발관시간，정향력회복시간。결과량조술후6 h、술후1、3、5、7 d시적MMSE평분표현출선강후승적추세，차관찰조술후6 h、술후1、3、5、7 d시적MMSE평분여술전화대조조비교유균유현저성차이( P<0．05혹P<0．01)。관찰조POCD발생솔위10．0%，대조조위26．7%，관찰조여대조조상비교유현저성차이(P<0．01)。연합조발생솔위16．7%，여대조조상비，구유현저성차이(P<0．01)。관찰조화연합조정향력회복시간、발관시간균저우대조조，상비교유현저성차이( P<0．05)。결론칠불미흡입마취대노년비소세포폐암환자술후인지공능영향소，환자술후소성질량교고，시노년비소세포폐암환자이상적마취유지방법，치득림상응용。
Objective To investigate the influence of inhalation anesthesia with sevoflurane on postoperative cognitive function and analepsia quality in elderly patients with non-small cell lung cancer ( NSCLC) . Methods 90 patients undergoing elective radical resection of lung cancer were randomly divided into the observation group, the control group and the combined group. The observation group received inhalation anesthesia with sevoflurane for maintaining anesthesia, the control group received propofol pump injection for maintaining anesthesia, and the com-bined administration group received sevoflurane and propofol. The other anesthetic regimens of the three groups were the same. The postoperative cognitive function of the three groups was evaluated in preoperative time, postoperative 6h, postoperative 1, 3, 5, 7 d by simple mental state score (MMSE) before operation and 6h, 1d, 3d, 5d and 7d after operation. At the same time, the open eyes, extubation time and orientation recovery time of patients were ob-served. Results Compared with preoperative MMSE scores, postoperative MMSE scores decreased obviously. And in the observation group, the postoperative MMSE scores showed significant differences with preoperative MMSE scores (P<0. 05). Moreover, postoperative MMSE scores of the observation group had a significant difference with that of the control group (P<0. 01). The POCD of the observation group was 10. 0%, the POCD of the combined administration group was 16. 7% and the control group was 26. 7%. (P<0. 01). The orientation recovery time and extubation time of the observation group and the combined administration group were lower than that of the control group (P<0. 01). Conclusion The inhalation anesthesia with sevoflurane has small impact on postoperative cogni-tive function and produces high quality of recovery in elderly patients with NSCLC. Therefore, it is the ideal method for maintaining anesthesia in elderly patients with NSCLC.