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目的 对比地氟烷、七氟烷和丙泊酚三种全身麻醉药物的不同组合方式对学龄儿童术后认知功能的影响。方法 选取2018年6月至2020年1月南华大学附属第二医院及南华大学附属第一医院择期行扁桃体和/或腺样体切除术患儿150例，年龄5～12岁，美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级。按照不同麻醉诱导及维持药物的组合，采用随机数字表法将患儿分为五组：七氟烷诱导+七氟烷维持组(SS组)，七氟烷诱导+丙泊酚维持组(SP组)，七氟烷诱导+地氟烷维持组(SD组)，丙泊酚诱导+丙泊酚维持组(PP组)以及丙泊酚诱导+地氟烷维持组(PD)组，每组30例。测试术前1 d(T0)及术后1 d(T1)皮博迪图片词汇测验(PPVT)评分和术后3 d、术后1个月、术后3个月联合型瑞文推理测验(CRT)评分。检测T0及T1血清中枢神经特异性蛋白(S100β)、神经元特异性烯醇化酶(NSE)血清浓度。记录苏醒时间、拔管时间、麻醉恢复室停留时间。结果 五组患儿PPVT评分及血清S100β蛋白浓度在T0、T1时间点之间差异无统计学意义(P > 0.05)，组间差异无统计学意义(P > 0.05)。五组患儿CRT评分在术后3 d、术后1个月及术后3个月之间差异无统计学意义(P > 0.05)，组间差异无统计学意义(P > 0.05)，五组患儿血清NSE浓度T1较T0升高，差异有统计学意义(P<0.05)，组间差异无统计学意义(P > 0.05)。SD组与PD组苏醒时间及拔管时间早于其他组，其中SD组时间最短，差异有统计学意义(P<0.05)。结论 地氟烷、七氟烷、丙泊酚不同诱导及维持组合对于无麻醉暴露史的学龄儿童未发现有认知功能损害，同时以地氟烷维持具有苏醒快、拔管早的优点，适宜儿科短小手术。
Abstract：Objective To compare the effects of different combinations of desflurane, sevoflurane, and propofol on postoperative cognitive function of school-age children. Methods A total of 150 children, aged 5-12 years old, of American Society of Anesthesiologists(ASA) physical status Ⅰ or Ⅱ, who underwent elective tonsil and/or adenoidectomy, from June 2018 to January 2020, in the Second Affiliated Hospital of University of South China and the First Affiliated Hospital of University of South China, were selected as the subjects. According to different combinations of induction and maintenance drugs, they were randomly divided into five groups: sevoflurane-induced and sevoflurane-maintenance group(SS group), sevoflurane-induced and propofol-maintenance group(SP group), sevoflurane-induced and desflurane-maintenance group(SD group), propofol-induced and propofol-maintenance group(PP group), propofol-induced and desflurane-maintenance group(PD group), with 30 cases in each group, according to random number table method. Peabody picture vocabulary test(PPVT) scores were assessed on the day before surgery(T0) and the day after surgery(T1), and combined Raven's test(CRT) scores were assessed at 3 d, 1 month, and 3 months after surgery. Serum concentrations of S100β protein and neuronspecific enolase(NSE) were measured at T0 and T1. Recovery time, extubating time, and PACU stay time were recorded. Results There were no statistically significant differences among the five groups in PPVT scores and serum S100β protein concentrations at T0 and T1(P > 0.05), and no statistically significant differences were observed among the groups(P > 0.05). The CRT scores of the five groups showed no statistically significant differences at 3 d, 1 month, and 3 months postoperatively(P > 0.05), and no statistically significant differences were found among the groups(P > 0.05). The NSE concentration of the five groups in serum at T1 was higher than that at T0, and this difference was statistically significant(P > 0.05), while there were no statistically significant differences among the groups(P > 0.05). The SD group and PD group had shorter recovery time and extubation time than other groups, with the SD group having the shortest time, showing statistically significant differences(P < 0.05). Conclusion Different combinations of induction and maintenance agents(desflurane, sevoflurane, and propofol) don't result in cognitive impairment in school-aged children without prior exposure to anesthesia. Additionally, maintenance with desflurane offers the advantages of rapid awakening and early extubation, making it suitable for short pediatric surgeries.
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基本信息:
中图分类号:R726.1
引用信息:
[1]谢叶青,刘欢,王燕,等.地氟烷、七氟烷、丙泊酚不同组合方式对学龄儿童术后认知功能的影响[J].麻醉安全与质控,2025,7(06):489-494.
基金信息:
湖南省自然科学基金联合项目（2018JJ6121）; 2023年湖南创新平台与人才计划（2023SK4014）
2025-12-15
2025-12-15
2025-12-15