依托咪酯和七氟烷麻醉对老年脊柱手术患者脑氧代谢、脑血流灌注和术后谵妄的影响  

Effects of etomidate and sevoflurane anesthesia on cerebral oxygen metabolism,cerebral blood flow perfusion and postoperative delusion in elderly patients undergoing spinal surgery

作　　者：李军[1] 侯唯艺 Li Jun;Hou Weiyi(Department of Anesthesiology,South District,Guang′anmen Hospital,China Academy of Chinese Medical Sciences,Beijin 102618,China)

机构地区：[1]中国中医科学院广安门医院南区麻醉科,北京102618

出　　处：《中国医师进修杂志》2024年第3期205-211,共7页Chinese Journal of Postgraduates of Medicine

基　　金：北京市医院管理中心临床医学发展专项经费资助项目(XMLX202151)。

摘　　要：目的探讨依托咪酯和七氟烷麻醉对老年脊柱手术患者脑氧代谢、脑血流灌注和术后谵妄的影响。方法采用前瞻性研究的方法,选择2020年3月至2021年5月于中国中医科学院广安门医院择期行脊柱手术的96例老年患者作为研究对象,按随机数字表法将所有患者分为七氟烷组和依托咪酯组各48例,七氟烷组采用七氟烷吸入镇痛,依托咪酯组采用依托咪酯静脉自控镇痛,记录两组患者自主呼吸恢复时间,唤醒时间,清醒拔管时间,术后1、3、6、12、24和48 h疼痛数字评分(NRS),术后谵妄发生率,颈内静脉血氧饱和度(SjvO2);并计算脑动静脉血氧含量差(AVDO2)和脑氧摄取率(CERO2)脑氧代谢指标;连续记录麻醉诱导前(T0)、意识消失后(T1)、注射麻醉药物后(T2)、气管插管后(T3)、手术开始前(T4)、术中30 min(T5)、术中60 min(T6)及术毕(T7)不同时间点大脑中动脉收缩峰值流速(Vs-MCA)、舒张期末流速(Vd-MCA)、平均流速(Vm-MCA)脑血流灌注指标。结果两组患者术后自主呼吸恢复时间、唤醒时间、清醒拔管时间比较差异均无统计学意义(P>0.05)。七氟烷组术后1、3、6、12、24和48 h静息NRS分别为(1.27±0.12)、(2.13±0.22)、(3.26±0.23)、(3.29±0.22)、(2.52±0.11)、(2.02±0.11)分;依托咪酯组分别为(1.27±0.13)、(2.02±0.21)、(2.13±0.13)、(2.11±0.26)、(2.08±0.17)、(1.02±0.17)分;重复测量方差分析结果显示,两组患者术后静息NRS比较差异有统计学意义(P<0.05)。两组患者不同时间点术后静息NRS比较差异有统计学意义(P<0.05)。依托咪酯组术后谵妄发生率明显低于七氟烷组[4.17%(2/48)比16.67%(8/48)],差异有统计学意义(P<0.05)。七氟烷组和依托咪酯组患者术后SjvO2均高于术前[(69.96±4.17)%比(58.26±4.16)%、(61.22±4.19)%比(58.25±4.17)%],且AVDO2、CERO2均低于术前[(60.23±5.22)%比(64.22±4.17)%、(50.23±6.19)%比(64.23±4.19)%,(37.22±6.23)%比(40.23±5.16)%、(31.26±5.17)%比(40.27±4.18Objective To study cerebral oxygen metabolism and cerebral blood flow in etomidate and sevoflurane anesthesia effects of perfusion and postoperative delusions.Methods A prospective study was used.The 96 elderly patients who underwent elective spinal surgery in Guang′anmen Hospital,China Academy of Chinese Medical Sciences from March 2020 to May 2021 were selected as the study subjects.All patients were divided into sevoflurane group and etomidide group by random numbers table,each with 48 cases.The sevoflurane group was treated with sevoflurane inhalation for analgesia,with etomidate intravenous-controlled analgesia in the etomidate group.The recovery time of spontaneous respiratory,wake time,awake extubation time,numerical rating score(NRS;1,3,6,12,24 and 48 h),incidence of postoperative delusion,internal jugular vein oxygen saturation(SjvO2)were recorded.Arteriovenous oxygen content(AVDO2)and cerebral oxygen intake rate(CERO2)were calculated.The peak cerebral artery constriction rate(Vs-MCA),diastolic velocity(Vd-MCA)and mean flow rate(Vm-MCA)pre-induction of anesthesia(T0),loss of consciousness(T1),after fentanyl injection(T3),endotracheal intubation(T4),30 min(T5),60 min(T6)and postoperative(T7)were recorded.Results There were no significant differences in the recovery time of spontaneous breathing,wake time and awake extubation time between the two groups(P>0.05).The resting NRS in sevoflurane group at 1,3,6,12,24 and 48 h after operation were(1.27±0.12),(2.13±0.22),(3.26±0.23),(3.29±0.22),(2.52±0.11)and(2.02±0.11)points,respectively.Etomidate group was(1.27±0.13),(2.02±0.21),(2.13±0.13),(2.11±0.26),(2.08±0.17)and(1.02±0.17)points,respectively.The results of repeated measurement ANOVA showed that there was significant difference in NRS between the two groups(P<0.05).There were significant differences in postoperative resting NRS between the two groups at different time points(P<0.05).The incidence of postoperative delusion in etomidate group was lower than that in sevoflurane group:4.17%(2/48)v

关 键 词：麻醉 依托咪酯 七氟烷 老年脊柱手术 脑血流灌注 术后谵妄 

分 类 号：R614[医药卫生—麻醉学]