地氟烷与七氟烷吸入麻醉对行全身麻醉下腹部手术老年患者苏醒质量及认知功能的影响比较  

Comparison of effects of desflurane and sevoflurane inhalation anesthesia on recovery quality and cognitive function of elderly patients undergoing abdominal surgery under general anesthesia

作　　者：张雪莹 李晓芳[1] 张红伟[1] 樊腾[1] 马闻苛 杨明月 高宁宁 王玉淼 郭自伟 常海宽 殷杰 岳修勤[1] ZHANG Xueying;LI Xiaofang;ZHANG Hongwei;FAN Teng;MA Wenke;YANG Mingyue;GAO Ningning;WANG Yumiao;GUO Ziwei;CHANG Haikuan;YIN Jie;YUE Xiuqin(Department of Anesthesiology,the First Affiliated Hospital of Xinxing Medical University,Weihui 453100,Henan Province,China)

机构地区：[1]新乡医学院第一附属医院麻醉科,河南卫辉453100

出　　处：《新乡医学院学报》2022年第8期726-730,共5页Journal of Xinxiang Medical University

基　　金：国家自然科学基金面上项目(编号:81870926);河南省医学科技攻关计划省部共建项目(编号:SBGJ2018054);河南省高等学校重点科研项目计划(编号:18B310020);河南省卫生科技创新型人才工程中青年科技创新人才基金资助项目(编号:20114155)。

摘　　要：目的比较麻醉维持期间单药吸入地氟烷或七氟烷对行全身麻醉下腹部手术老年患者的苏醒质量及认知功能的影响。方法选择2020年10月至2021年6月新乡医学院第一附属医院收治的60例全身麻醉下行腹部手术的老年患者为研究对象,按随机数字表法将患者分为对照组和观察组,每组30例。对照组患者吸入体积分数1.5%~2.0%七氟烷-氧气混合气体进行麻醉维持,观察组患者吸入体积分数4.5%~5.5%地氟烷-氧气混合气体进行麻醉维持。2组患者于麻醉诱导前(T_(0))、插管后(T_(1))、切开皮肤时(T_(2))、术中操作时(T_(3))、缝合皮肤时(T_(4))使用多功能监测仪监测心率(HR)和平均动脉压(MAP);记录比较2组患者的唤醒睁眼时间及定向力恢复时间;分别于术前和术后1、6、12、24、48 h时,应用简易智力状态检查量表(MMSE)评估2组患者的认知功能;比较2组患者术后恶心呕吐、躁动及支气管痉挛等并发症的发生情况。结果T_(0)、T_(1)、T_(2)、T_(3)、T_(4)时对照组与观察组患者的MAP及HR比较差异无统计学意义(P>0.05),2组患者T_(0)、T_(1)、T_(2)、T_(3)、T_(4)时MAP及HR比较差异均无统计学意义(P>0.05)。观察组患者的唤醒睁眼时间及定向力恢复时间显著短于对照组(P<0.05)。术前和术后24、48 h,对照组与观察组患者的MMSE评分比较差异无统计学意义(P>0.05)。术后1、6、12 h,观察组患者的MMSE评分显著高于对照组(P<0.05)。2组患者术后1、6、12 h时的MMSE评分显著低于术前和术后24、48 h(P<0.05)。对照组和观察组患者术后并发症发生率分别为26.7%(8/30)、20.0%(6/30),2组患者并发症发生率比较差异无统计学意义(χ^(2)=0.370,P>0.05)。结论与吸入七氟烷相比,全身麻醉下行腹部手术老年患者吸入地氟烷可缩短术后唤醒睁眼时间及定向力恢复时间,提高复苏质量,减轻对患者术后早期认知功能的影响。Objective To compare the effects of single-drug inhaled desflurane or sevoflurane during anesthesia maintenance on the recovery quality and cognitive function of elderly patients undergoing abdominal surgery under general anesthesia.Methods A total of 60 elderly patients undergoing abdominal surgery under general anesthesia in the First Affiliated Hospital of Xinxiang Medical University from October 2020 to June 2021 were selected as the research subjects,and they were divided into control group and observation group according to the random number table method,with 30 cases in each group.The patients in the control group inhaled 1.5%-2.0%volume fraction of sevoflurane-oxygen mixed gas for anesthesia maintenance,and the patients in the observation group inhaled 4.5%-5.5%volume fraction of desflurane-oxygen gas mixture for anesthesia maintenance.The heart rate(HR)and mean arterial pressure(MAP)of patients in the two groups were monitored by using a multi-function monitor before anesthesia induction(T_(0)),after intubation(T_(1)),during skin incision(T_(2)),during intraoperative operation(T_(3)),and during skin suture(T_(4)).The wake-up eye-opening time and orientation recovery time of patients in the two groups were recorded and compared;the cognitive function of patients in the two groups was evaluated by using the simple mental state examination(MMSE)scale before surgery and 1,6,12,24,48 hours after surgery,respectively.The incidence of postoperative complications such as nausea and vomiting,agitation and bronchospasm was compared between the two groups.Results There was no significant difference in MAP and HR of patients between the control group and the observation group at T_(0),T_(1),T_(2),T_(3)and T_(4)(P>0.05).There was no significant difference in HR and HR of patients at T_(0),T_(1),T_(2),T_(3)and T_(4)in the two groups(P>0.05).The wake-up eye-opening time and orientation recovery time of patients in the observation group were significantly shorter than those in the control group(P<0.05).There was no sign

关 键 词：地氟烷 七氟烷 老年患者 苏醒质量 认知功能 

分 类 号：R614[医药卫生—麻醉学]