七氟醚与丙泊酚对经皮肾镜取石术后肾功能及认知功能的影响  

Comparison between the Effects of Sevoflurane and Propofol on Postoperative Renal Function and Cognitive Function in Percutaneous Nephrolithotomy

作　　者：郭丽丽[1] 姜艳华[1] 田阿勇[1] GUO Lili;JIANG Yanhua;TIAN Ayong(Department of Anesthesiology,The First Hospital,China Medical University,Shenyang 110001,China)

机构地区：[1]中国医科大学附属第一医院麻醉科,沈阳110001

出　　处：《中国医科大学学报》2019年第5期414-416,424,共4页Journal of China Medical University

基　　金：辽宁省科学技术计划(2012225021)

摘　　要：目的比较七氟醚与丙泊酚对老年患者经皮肾镜取石术后肾功能及认知功能的影响。方法选取2015年5月至2017年5月于我院接受经皮肾镜取石术的老年患者90例。用随机数字表法将患者分为七氟醚组(七氟醚2%～4%吸入麻醉)与丙泊酚组(丙泊酚3.0～3.5μg/mL靶控静脉输注),每组45例。对比不同时间点[术前1 d (T1)、术后1 h (T2)、术后1 d (T3)、术后3 d (T4)] 2组患者血清肌酐(Cr)、血清尿素氮(BUN)水平及认知功能评分(MOCA及MMSE评分)。结果 2组患者体质量指数、手术时间及麻醉时间均无统计学差异(P> 0.05)。2组患者T1时血清Cr、BUN水平均无明显差异(均P> 0.05)。T2、T3、T4时,2组患者Cr、BUN水平均较T1时升高,T3时达到顶峰,T4时开始下降;七氟醚组Cr、BUN水平均高于丙泊酚组,差异均有统计学意义(均P <0.05)。2组术后MOCA及MMSE评分均低于术前,丙泊酚组术后MOCA及MMSE评分高于七氟醚组,差异有统计学意义(P <0.05)。结论经皮肾镜取石术中应用丙泊酚比七氟醚更安全,能减少对患者肾功能的损害及术后认知功能的影响。Objective To compare the effects of sevoflurane and propofol on renal function and cognitive function in elderly patients undergoing percutaneous nephrolithotomy. Methods A total of 90 elderly patients who underwent percutaneous nephrolithotomy in our hospital from May 2015 to May 2017 were enrolled. Patients were divided into a sevoflurane group( sevoflurane 2%-4% inhalation anesthesia) and a propofol group( propofol 3.0-3.5 μg/mL target-controlled intravenous infusion) using a random number table method. There were 45 patients in each group. Serum creatinine( Cr) and blood urea nitrogen( BUN) levels and cognitive function scores( MOCA and MMSE scores) were compared between the groups at different time points( T1: 1 d before surgery;T2: 1 h after surgery;T3: 1 d after surgery;T4: 3 d after surgery). Results There was no significant difference in body mass index, duration of operation and anesthesia, and serum Cr and BUN levels at T1 between the groups( P > 0.05). Cr and BUN levels of the patients in both the groups at T2, T3, and T4 were higher than those at T1. The levels peaked at T3 and began to decline from T4;the corresponding Cr and BUN levels in the sevoflu- rane group were higher than those in the propofol group, with statistically significant difference( all P < 0.05). MOCA and MMSE scores after surgery were lower in both the groups than those before surgery. Postoperative MOCA and MMSE scores of patients in the sevoflu- rane group were higher than those of patients in the propofol group, and the difference was statistically significant( P < 0.05). Conclusion Propofol is safer than sevoflurane in percutaneous nephrolithotomy, and it can help reduce the damage to renal function and postoperative cognitive function.

关 键 词：七氟醚 丙泊酚 经皮肾镜取石术 肾功能 认知功能 

分 类 号：R614.2[医药卫生—麻醉学]