七氟醚复合麻醉与丙泊酚全凭静脉麻醉对老年患者腹腔镜手术PND的影响  

Effect of combined sevoflurane anesthesia and total intravenous anesthesia with propofol on perioperative neurocognitive disorder in elderly patients during laparoscopic surgery

作　　者：叶梦霞 栾国凤 杜晨 田刚[2] Ye Mengxia;Luan Guofeng;Du Chen;Tian Gang(Department of Anesthesiology,the Central Hospital of Jingzhou,Jingzhou 434000,China;Department of Anesthesiology,the People's Hospital of Shiyan,Shiyan 442000,China)

机构地区：[1]荆州市中心医院麻醉科,荆州434000 [2]十堰市人民医院麻醉科,十堰442000

出　　处：《国际麻醉学与复苏杂志》2022年第4期371-375,共5页International Journal of Anesthesiology and Resuscitation

摘　　要：目的比较七氟醚复合麻醉与丙泊酚全凭静脉麻醉对老年患者腹腔镜手术围手术期神经认知障碍(perioperative neurocognitive disorders, PND)的影响。方法选取2019年9月—2020年9月在十堰市人民医院普通外科行腹腔镜手术的患者98例, 年龄60~75岁, ASA分级Ⅰ、Ⅱ级, 采用随机数字表法将患者分为两组(每组49例):七氟醚复合麻醉组(S组)和丙泊酚全凭静脉麻醉组(P组)。两组麻醉其他用药相同基础上, S组持续吸入2.0%~3.5%七氟醚, P组靶控输注丙泊酚(血浆靶浓度维持在3~6 mg/L)。记录两组患者术中情况(麻醉时间、手术时间、失血量、补液量、瑞芬太尼用量)及术后恢复情况(拔管时间、PACU停留时间、术后3 d VAS疼痛评分), 记录两组患者插管前(T_(0))、插管后(T_(1))、手术结束(T_(2))、入PACU (T_(3))时的MAP、心率及术后3、5、7、30 d PND的发生率。结果与S组比较, P组拔管时间、PACU停留时间缩短(P<0.05), 术后3、5、7 d PND的发生率降低(P<0.05)。两组患者手术时间、麻醉时间、失血量、补液量、瑞芬太尼用量、各时点心率、各时点MAP、术后3 d VAS疼痛评分、术后30 d PND发生率比较, 差异均无统计学意义(P>0.05)。结论与七氟醚复合麻醉相比, 丙泊酚全凭静脉麻醉能够缩短患者拔管时间与PACU停留时间, 并降低PND短期发病率, 提示丙泊酚静脉麻醉可能对老年患者更有益。Objective To compare the effects of combined sevoflurane anesthesia and total intravenous anesthesia with propo‑fol on perioperative neurocognitive disorder(PND)in elderly patients during laparoscopic surgery.Methods A total of 98 patients,aged 60-75 years,and American Society of Anesthesiologists gradesⅠorⅡ,who underwent laparoscopic surgery in the People's Hos‑pital of Shiyan from September 2019 to September 2020 were enrolled.According to the random number table method,the patients were divided into two groups(n=49):a combined sevoflurane anesthesia group(group S)and a total intravenous anesthesia with propo‑fol group(group P).On the basis of the same other anesthetics in the two groups,group S continued to inhale 2.0%-3.5%sevoflurane,while group P received target‑controlled infusion of propofol,where the plasma target concentration was maintained at 3-6 mg/L.Both groups were compared for intraoperative conditions(anesthesia time,operation time,blood loss,fluid volume,and remifentanil dosage)and postoperative recovery[extubation time,the length of postanesthesia care unit(PACU)stay,and postoperative Visual Analogu Scale(VAS)score at 3 days].Their mean artery pressure(MAP)and heart rate before intubation(T_(0)),after intubation(T_(1)),after opera‑tion(T_(2)),and after entering the PACU(T_(3)),and the incidence of PND 3,5,7,and 30 days after surgery were recorded.Results Com‑pared with group S,group P showed decreases in the extubation time and the length of PACU stay(P<0.05),and decreases in the inci‑dence of PND 3,5,and 7 days after operation(P<0.05).There was no statistical difference in the operation time,anesthesia time,blood loss,fluid volume,remifentanil dosage,heart rate and MAP at each time point,postoperative VAS pain score at 3 days,and the inci‑dence of PND 30 days after operation between the two groups(P>0.05).Conclusions Compared with sevoflurane anesthesia,total intravenous anesthesia with propofol can shorten the extubation time and the length of PACU stay,and reduce the short

关 键 词：围手术期神经认知障碍 七氟醚 丙泊酚 老年人 腹腔镜检查 

分 类 号：R614[医药卫生—麻醉学]