Department of Anesthesia, The Second People's Hospital of Hefei, The Affiliated Hefei Hospital of Anhui Medical University, No 246 Heping Road, Yaohai District, Hefei, 230011, Anhui, China.
Aging Clin Exp Res. 2019 Dec;31(12):1791-1800. doi: 10.1007/s40520-019-01123-8. Epub 2019 Mar 7.
This study was aimed to systematically evaluate the effects of fentanyl and sufentanil on intraoperative cerebral oxygen saturation changes and postoperative cognitive function in elderly patients undergoing open surgery. Ninety-six elderly patients who had undergone open surgery under general anesthesia were randomly divided into fentanyl group (F group, anesthesia by fentanyl, 4 g/kg) and sufentanil group (S group, anesthesia by sufentanil, 0.4 µg/kg). There were no significant differences between the F group and S group in the general characteristics of patients. Compared to the F group, the S group had a better effect on suppressing the stress response, maintaining a stable hemodynamic status and achieving better anesthesia effects. The anesthesia recovery time of the S group was significantly shorter than that of the F group. There was no significant difference between the two groups in the intraoperative and postoperative agitation. Patient's waking time and extubation time were significantly shorter in the S group than the F group. The VAS scores in the S group were significantly lower than those in the F group at each time point. The Ramsay scores in the S group were significantly higher than those in the F group at each time point. The cerebral oxygen saturation (SctO) levels in both groups were significantly increased following anesthesia induction and intubation compared to that of the awake state (P < 0.05), and SctO was significantly decreased during the surgery in both groups. The changes in SctO levels were not significantly different between the two groups (P > 0.05). The SctO level was significantly higher during surgery than that after intubation. Compared with the F group, the relative value of SctO decline in the S group was smaller. Compared to the day before surgery, the Montreal Cognitive Assessment (MoCA) scores of both groups were significantly reduced after surgery. At 1 day post-surgery, the MoCA scores of the S group were significantly higher and the incidence of postoperative cognitive dysfunction (POCD) was significantly lower compared to the F group. POCD occurred in three patients (6.2%) in the S group, and the ratio was significantly lower than that in the F group (11.9%) (P < 0.05). It showed a consistent trend with the SctO status during the surgery. The relative value of SctO decline in the S group was significantly smaller than that in the F group. The reduction of cognitive function in the S group was significantly lower than that in the F group. These results indicate that the changes in SctO are a good prediction of the incidence of POCD.
本研究旨在系统评价芬太尼和舒芬太尼对老年患者全麻开腹手术术中脑氧饱和度变化及术后认知功能的影响。96 例行全麻开腹手术的老年患者随机分为芬太尼组（F 组，麻醉用芬太尼，4μg/kg）和舒芬太尼组（S 组，麻醉用舒芬太尼，0.4μg/kg）。F 组和 S 组患者的一般特征无显著差异。与 F 组相比，S 组在抑制应激反应、维持稳定的血流动力学状态和获得更好的麻醉效果方面效果更好。S 组的麻醉恢复时间明显短于 F 组。两组患者术中及术后躁动无显著差异。S 组患者清醒时间和拔管时间明显短于 F 组。S 组患者各时间点的 VAS 评分明显低于 F 组。S 组各时间点 Ramsay 评分明显高于 F 组。两组患者麻醉诱导及插管后脑氧饱和度（SctO）均较清醒状态时明显升高（P<0.05），术中 SctO 均较下降。两组间 SctO 水平变化无显著差异（P>0.05）。SctO 水平术中较插管后高。与 F 组相比，S 组 SctO 下降的相对值较小。与术前 1 天相比，两组术后蒙特利尔认知评估（MoCA）评分均明显降低。术后 1 天，S 组 MoCA 评分明显高于 F 组，术后认知功能障碍（POCD）发生率明显低于 F 组。S 组发生 POCD 3 例（6.2%），明显低于 F 组（11.9%）（P<0.05）。与术中 SctO 状态呈一致趋势。S 组 SctO 下降的相对值明显小于 F 组。S 组认知功能下降明显低于 F 组。这些结果表明，SctO 的变化是预测 POCD 发生率的一个很好的指标。
