丙泊酚复合依托咪酯麻醉对颈动脉内膜剥脱术患者脑组织氧饱和度、术后认知功能的影响  

Effect of propofol combined with etomidate anesthesia on cerebral oxygen saturation and postoperative cognitive function in patients with carotid endarterectomy

作　　者：刘秀兰 李荣华[2] 孙文浩[3] 纪国余 李建玲[1] Liu Xiulan;Li Ronghua;Sun Wenhao;Ji Guoyu;Li Jianling(Department of Anesthesiology,Affiliated Hospital of Chengde Medical University,Chengde 067000,Hebei,China;Department of Vascular Hernia Surgery,Affiliated Hospital of Chengde Medical University,Chengde 067000,Hebei,China;Department of Neurosurgery,Affiliated Hospital of Chengde Medical University,Chengde 067000,Hebei,China)

机构地区：[1]承德医学院附属医院麻醉科,河北承德067000 [2]承德医学院附属医院血管疝外科,河北承德067000 [3]承德医学院附属医院神经外科,河北承德067000

出　　处：《血管与腔内血管外科杂志》2022年第6期723-728,共6页Journal of Vascular and Endovascular Surgery

基　　金：承德市科学技术研究与发展计划(202109A035)。

摘　　要：目的探讨丙泊酚复合依托咪酯麻醉对颈动脉内膜剥脱术(CEA)患者脑组织氧饱和度(StO_(2))、术后认知功能的影响。方法收集2020年1月至2022年1月于承德医学院附属医院接受CEA治疗的92例患者的临床资料,根据麻醉方式的不同将患者分为常规组(采用七氟醚和瑞芬太尼维持麻醉)和丙泊酚组(采用丙泊酚复合依托咪酯麻醉),每组46例。观察两组患者不同时间点(麻醉诱导前、意识消失即刻、手术开始后30 min、术毕即刻)的血流动力学指标[平均动脉压(MAP)、心率(HR)]、心功能指标[心脏指数(CI)、呼气末二氧化碳分压(PetCO_(2))、脑电双频指数(BIS)]。比较两组患者颈动脉阻滞前后的氧化应激反应指标[血清脂质过氧化物(LPO)、丙二醛与低密度脂蛋白比值(MDA/LDL)、S100钙结合蛋白B(S100B)]。比较两组患者术前、术后24 h的认知功能指标[简易精神状况检查(MMSE)量表、蒙特利尔认知评估量表(MoCA)、韦克斯勒记忆量表(WMS)评分]及术后并发症发生情况。结果意识消失即刻、手术开始后30 min、术毕即刻,丙泊酚组患者的MAP、HR、CI均明显高于常规组患者,差异均有统计学意义(P<0.01)。手术开始后30 min、术毕即刻,丙泊酚组患者的StO_(2)均明显高于常规组患者,PetCO_(2)均明显低于常规组患者,差异均有统计学意义(P<0.01)。意识消失即刻、手术开始后30 min,丙泊酚组患者的BIS均明显高于常规组患者,差异均有统计学意义(P<0.01)。颈动脉阻断后,丙泊酚组患者的血清LPO、MDA/LDL、S100B水平均低于常规组患者,差异均有统计学意义(P<0.05)。术后24 h,丙泊酚组患者的MMSE、MoCA、WMS评分均高于常规组患者,差异均有统计学意义(P<0.05)。丙泊酚组患者的术后并发症总发生率低于常规组患者,差异有统计学意义(P<0.05)。结论丙泊酚复合依托咪酯麻醉对患者术中血流动力学、心功能的影响更轻微,能够提高CEA术中的StO_(Objective To investigate the effect of propofol combined with etomidate anesthesia on cerebral tissue oxygen saturation(StO_(2))and postoperative cognitive function in patients with carotid endarterectomy(CEA).Method The clinical data of 92 cases patients who underwent CEA in Affiliated Hospital of Chengde Medical University from January 2020 to January 2022 were collected.According to different anesthesia methods,they were divided into routine group(sevoflurane and remifentanil were used to maintain anesthesia)and propofol group(propofol combined with etomidate anesthesia),with 46 cases in each group.The hemodynamic indexes of the two groups at different time points(before anesthesia induction,immediately after unconsciousness,thirty minutes after the beginning of surgery,and immediately after surgery)were observed.The hemodynamic indexes include mean arterial pressure(MAP),heart rate(HR);cardiac function indexes[cardiac index(CI)、StO_(2)、partial pressure of end-tidal carbon dioxide(PetCO_(2)),bispectral index(BIS)].The indexes of oxidative stress response[lipid hydroperoxide(LPO),malondialdehyde to low density lipoprotein ratio(MDA/LDL),S100 calcium-binding protein B(S100B)]before and after carotid artery block were compared between the two groups.The cognitive function[mini-mental state examination(MMSE)scale,Montreal cognitive assessment scale(MoCA),Wechsler memory scale(WMS)]and postoperative complications of the two groups were compared before and twenty-four hours after operation.Result MAP,HR and CI of patients in propofol group were significantly higher than those in routine group immediately after unconsciousness,thirty minutes after the beginning of surgery and immediately after surgery,and the differences were statistically significant(P<0.01).Thirty minutes after the beginning of surgery and immediately after surgery,the StO_(2) of propofol group was significantly higher than that of routine group,and PetCO_(2) was significantly lower than that of routine group,and the differences were statistica

关 键 词：颈动脉内膜剥脱术 丙泊酚 七氟醚 依托咪酯 脑组织氧饱和度 认知功能 

分 类 号：R543.4[医药卫生—心血管疾病]