七氟烷与丙泊酚联合右美托咪定对行腹腔镜胆囊切除术患者术后认知功能及氧化应激反应的影响  

Effects of Sevoflurane and propofol combined with dexmedetomidine on the postoperative cognitive function and oxidative stress response in laparoscopic gallbladder resection

作　　者：陈元良[1] 徐丽丽[2] 蓝志坚[1] 张磊[1] 

机构地区：[1]金华市中心医院麻醉科,浙江金华321000 [2]浙江中医药大学附属第二医院麻醉科,浙江杭州310005

出　　处：《中华全科医学》2017年第8期1283-1285,共3页Chinese Journal of General Practice

基　　金：国家自然科学基金(81400929)

摘　　要：目的探讨七氟烷与丙泊酚联合右美托咪定对行腹腔镜胆囊切除术患者术后认知功能及氧化应激反应的影响。方法将74例行腹腔镜胆囊切除术患者分为2组。全部患者给予术前肌注右美托咪定,采用咪达唑仑、芬太尼进行麻醉诱导,观察组给予吸入七氟烷与靶控输注右美托咪定进行麻醉维持;对照组给予靶控输注丙泊酚联合右美托咪定进行麻醉维持。对比2组术后恢复情况;采用简易精神状态量表(MMSE)评分评价患者术后认知功能变化;于手术前后检测患者S100β蛋白、氧化应激指标。结果 2组手术时间对比差异无统计学意义(P>0.05);观察组睁眼时间、拔管时间、定向力恢复时间显著少于对照组,差异有统计学意义(t=5.870、10.226、8.527,均P<0.05);术后6 h、12 h、24 h,观察组MMSE评分显著高于对照组,差异有统计学意义(t=3.417、3.800、3.048,均P<0.05);术后24 h,观察组S100β蛋白显著低于对照组,差异有统计学意义(t=4.768,P<0.05);2组术后超氧化物歧化酶(SOD)、丙二醛(MDA)显著提高,总抗氧化能力(T-AOC)显著降低(均P<0.05);观察组术后SOD、MDA显著低于对照组,T-AOC显著高于对照组,差异有统计学意义(t=4.689、4.073、8.518,均P<0.05)。结论与丙泊酚相比,七氟烷复合右美托咪定能显著减轻腹腔镜胆囊切除术患者的术后氧化应激反应,保护认知功能。Objective To explore the effects of sevoflurane and propofol combined with medetomidine in peritoneoseope gallbladder resection and postoperative cognitive function and oxidative stress response. Methods Altogether 74 cases of laparoseopic cholecysteetomy were divided into two groups. All patients were given preoperative intramuscular injection of dexmedetomidine with midazolam and fentanyl for anesthesia induction. The observation group was given inhalation of sevoflurane with target controlled infusion of dexmedetomidine for maintenance of anesthesia. The control group was given propofol target controlled infusion combined with dexmedetomidine for maintenance of anesthesia. Postoperative recovery was compared between the two groups. Changes of postoperative cognitive function in patients were assessed with minimental state examination（MMSE） score. Changes of S100 beta protein and oxidative stress in patients were detected before and after surgery. Results There was no significant difference in the operation time between the two groups （P 〉 0.05 ）. The observation group awake time and extubation time, recovery time were significantly lower than those in the control group. The difference was statistically significant（ t = 5. 870,10. 226,8. 527, P 〈 0.05 ）. At 6 hours, 12 hours and 24 hours after operation, the MMSE score of the observation group was significantly higher than that of the control group. The difference was statistically significant（ t = 3. 417,3. 800,3. 048 ,P 〈 0.05 ）. 24h after operation, the observation group S100 beta protein was significantly lower than the control group. The difference was statistically significant （t = 4.768,P 〈 0.05 ）. SOD and MDA were significantly improved after operation in two groups, and T-AOC was significantly decreased （P 〈 0.05）. For the observation group MDA and SOD were significantly lower than those in the control group. T-AOC was significantly higher than the control group. The difference was statistically significant （ t = 4.

关 键 词：七氟烷 丙泊酚 右美托咪定 腹腔镜胆囊切除术 认知功能 氧化应激反应 

分 类 号：R657.4[医药卫生—外科学] R971.2[医药卫生—临床医学]