静吸复合麻醉与全凭静脉麻醉对老年子宫肌瘤患者腹腔镜剥除术后认知功能及血流动力学影响  

Effects of the combined intravenous-inhalation anesthesia and the total intravenous anesthesia during laparoscopic myomectomy of elderly patients on their postoperative cognitive function and hemodynamics

作　　者：王辉 邓雪峰 耿兴强 WANG Hui;DENG Xuefeng;GENG Xingqiang(Guoyang County Hospital of traditional Chinese Medicine,Anhui Province,233600;The First Affiliated Hospitalof Anhui University of traditional Chinese Medicine)

机构地区：[1]安徽省涡阳县中医院,233600 [2]安徽省中医药大学第一附属医院

出　　处：《中国计划生育学杂志》2023年第6期1316-1320,共5页Chinese Journal of Family Planning

摘　　要：目的:探讨静吸复合麻醉(CIVIA)与全凭静脉麻醉(TIVA)对老年子宫肌瘤患者腹腔镜剥除术后认知功能及血流动力学影响。方法:选取2019年1月-2021年12月本院接受腹腔镜剥除术老年子宫肌瘤患者90例,根据全身麻醉方式分为TIVA组(45例)和CIVIA组(45例),分析两组围术期血流动力学指标、应激反应指标以及简易智能量表(MMSE)评分。结果:麻醉诱导前和麻醉诱导后心率(HR)、平均动脉压(MAP)以及皮质醇(Cor)、去甲肾上腺素(NE)、血管紧张素Ⅰ(AngⅠ)、空腹血糖(FPG)等应激反应指标两组比较均无差异(均P>0.05);而在气管插管、术毕、术后6 h时,两组上述指标均低于麻醉诱导后,且CIVIA组低于TIVA组(均P<0.05)。MMSE评分两组麻醉后6h、12h、24h时均低于麻醉诱导前,但CIVIA组麻醉后12h(26.31±1.19分)、24h(28.76±0.81分)评分均高于TIVA组(25.19±2.25分、27.56±0.89分)(均P<0.05)。结论:CIVIA能有效减轻老年子宫肌瘤患者腹腔镜剥除术后应激反应,血流动力学指标更稳定,术后认知功能损伤更小。Objective:To investigate the effects of the combined intravenous-inhalation anesthesia(CIVIA)and the total intravenous anesthesia(TIVA)during laparoscopic myomectomy of elderly patients on their postoperative cognitive function and hemodynamics.Methods:90elderly patients with hysteromyoma who wanted laparoscopic myomectomy were selected and divided into TIVA group(45cases)and CIVIA group(45cases)according to the mode of general anesthesia from January 2019to December 2021.The perioperative hemodynamic indexes,the stress response indexes,and the score of mini-mental state examination(MMSE)of the patients in the two groups were analyzed.Results:The values of heart rate(HR)and mean arterial pressure(MAP),and the levels of cortisol(Cor),norepinephrine(NE),angiotensinⅠ(AngⅠ),fasting blood glucose(FPG),and other stress response indexes of the patients had no significant differences between the two groups(all P>0.05),but which of the patients in the two groups after endotracheal intubation,after surgery,and at 6hafter surgery were significantly lower than those after anesthesia induction,and which of the patients in CIVIA group were significantly lower than those of the patients in TIVA group(all P<0.05).The MMSE score of the patients in the two groups at 6h,12h,and 24hafter anesthesia were significantly lower than those before anesthesia induction,but the MMSE score of the patients in CIVIA group at 12h(26.31±1.19points)and 24h(28.76±0.81points)were significantly higher than those(25.19±2.25points and 27.56±0.89points)of the patients in TIVA group(all P<0.05).Conclusion:CIVIA can effectively reduce the stress response of the elderly patients with hysteromyoma after laparoscopic myomectomy,and which can stabilize the hemodynamic indexes and can decrease the postoperative cognitive function of the patients.

关 键 词：腹腔镜子宫肌瘤剥除术 静吸复合麻醉 全凭静脉麻醉 血流动力学 应激反应 术后认知功能 

分 类 号：R614[医药卫生—麻醉学] R737.33[医药卫生—外科学]