关键词: 异丙酚, 硬膜外麻醉, 镇静, 心理应激, 认知

Abstract: AIM: To investigate the effects of epidural anesthesia combined with propofol sedation on postoperative cognition in the elder.METHODS: 160 patients, aged 65-80 years with primary school educational level, scheduled for transurethral resection of the prostate (TURP), were randomly assigned into two groups (n=80 each group) :control group and test group.Patients in control group received only epidural anesthesia.Patients in test group received epidural anesthesia combined with propofol sedation.Propofol was administered by target controlled infusion (TCI), the effect-site concentration was adjusted according to the number of bispectral index (BIS) by hand, maintain the number of BIS near 80.A battery of 8 neuropsychological tests were performed the day before surgery and the fifth day after surgery to evaluate cognition. The mean arterial pressure (MAP) was recorded every 5 min during operation.Patient comfort and satisfaction with the anesthesia was assessed 30 min after surgery. RESULTS: The MAP was lower, the score of patient comfort and satisfaction with the anesthesia was higher in test group compared with control group (P<0.05). The scores of Rey auditory verbal learning test and digit span forward changed no significantly between pre-and post-operation in test group (P>0.05).The score of Rey auditory verbal learning test in test group was better than that of control group 5 days postoperatively. There was no significant difference of incidence of postoperative cognitive dysfunction (POCD) between the two groups (P>0.05).CONCLUSION: Using propofol sedation combined with epidural anesthesia to reduce psychological stress during operation, may reduce the postoperative memory impairment in some degree in the elder, and with a excellent patient comfort and satisfaction about anesthesia, but contribute to reduce the incidence of POCD is very limited.

Key words: propofol, epiduralanesthesia, sedation, psychologicalstress, cognition