不同剂量瑞芬太尼复合丙泊酚闭环靶控麻醉对高血压老年患者内镜下逆行胰胆造影后认知功能的影响  

Effects of different doses of remifentanil combined with propofol of closed loop target controlled anesthesia on cognitive function after endoscopic retrograde cholangiopancreatography in elderly patients with hypertension

作　　者：张顺利[1] 乔建业[2] 任志明[3] 高瑞[1] ZHANG Shunli;QIAO Jianye;REN Zhiming;GAO Rui(Department of Anesthesiology,the Second Affiliated Hospital of Baotou Medical College,Inner Mongolia,Baotou,014030,China;Department of E.N.T.,the Central Hospital of Baotou,Inner Mongolia,Baotou,014030,China;Department of Anesthesiology,the Fourth Hospital of Baotou,Inner Mongolia,Baotou,014030,China)

机构地区：[1]包头医学院第二附属医院麻醉科,内蒙古包头014030 [2]包头市中心医院耳鼻咽喉头颈外科,内蒙古包头014030 [3]包头市第四医院麻醉科,内蒙古包头014030

出　　处：《当代医学》2024年第3期1-6,共6页Contemporary Medicine

基　　金：包头市科技计划项目(2019Z3011-02)。

摘　　要：目的探讨不同剂量瑞芬太尼复合丙泊酚闭环靶控麻醉对高血压老年患者内镜下逆行胰胆造影(ERCP)后认知功能的影响。方法选取2019年11月至2021年2月于包头医学院第二附属医院行无痛ERCP的180例患者作为研究对象,采用随机数字表法分为A组、B组及C组,每组60例。每组采用不同剂量瑞芬太尼复合丙泊酚闭环靶控麻醉,A组、B组、C组丙泊酚注入前分别静脉滴注瑞芬太尼0.5、0.8、1μg/kg。比较3组术中丙泊酚用量、苏醒时间、血流动力学指数及术后炎症因子水平、认知功能。结果A组丙泊酚用量多于B组和C组,A组和B组苏醒时间均短于C组,差异有统计学意义(P<0.05)。T1时,A组心率(HR)慢于B组但高于C组,A组、B组平均动脉压(MAP)均高于C组,差异有统计学意义(P<0.05);T2~T3时,A组HR快于B组、C组,MAP高于B组、C组,且B组HR快于C组,MAP高于C组,差异有统计学意义(P<0.05);T4时,A组、B组HR均快于C组,A组MAP高于B组、C组,差异有统计学意义(P<0.05)。麻醉前,3组血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平比较差异无统计学意义;术后6h,A组、B组血清IL-6、TNF-α水平高于C组,且A组血清IL-6水平高于B组,差异有统计学意义(P<0.05);术后12h,A组、B组血清IL-6水平低于C组,A组、B组血清TNF-α水平高于C组,差异有统计学意义(P<0.05)。术后1、3d,A组术后认知功能障碍(POCD)发生率均高于B组和C组,且B组POCD发生率低于C组,差异均有统计学意义(P<0.05)。结论不同剂量瑞芬太尼复合丙泊酚闭环靶控麻醉均能成功地应用于实施ERCP的高血压老年患者,但0.8μg/kg的剂量能明显降低POCD发生率。Objective To investigate the effects of different doses of remifentanil combined with propofol of closed loop target controlled anesthe-sia on cognitive function after endoscopic retrograde cholangiopancreatography(ERCP)in elderly patients with hypertension.Methods A total of 180 patients who received painless ERCP in the Second Affiliated Hospital of Baotou Medical College from November 2019 to February 2021 were select-ed as the study subjects,and they were divided into the group A,group B and group C by random number method,with 60 cases in each group.Each group was given different doses of remifentanil combined with propofol closed loop target control anesthesia,and group A,group B and group C were given intravenous remifentanil 0.5,0.8 and 1μg/kg,respectively,before propofol injection.Intraoperative propofol dosage,recovery time,hemody-namic index and postoperative inflammatory factor levels were recorded,and cognitive function were compared between the two groups.Results The dosage of propofol in group A was more than that in group B and group C,and the recovery time in group C was longer than that in group A and group B,and the differences were statistically significant(P<0.05).At T1,the heart rate(HR)in the group A was slower than the group B but higher than the group C,and the mean arterial pressure(MAP)in the group A and group B was higher than that in the group C,and the differences were statistical-ly significant(P<0.05);at T2-T3,HR in the group A was faster than that in the group B and the group C,and MAP was higher than that in the group B and the group C,and HR in the group B was faster than the group C,MAP was higher than the group C,and the differences were statistically signifi-cant(P<0.05);at T4,HR in the group A and the group B was faster than the group C,and MAP in the group A was higher than that in the group B and group C,and the differences were statistically significant(P<0.05).Before anesthesia,there were no significant differences in serum levels of inter-leukin-6(IL-6)and tumor necros

关 键 词：内镜下逆行胰胆造影 瑞芬太尼 丙泊酚 闭环靶控 高血压 老年 认知功能 

分 类 号：R614[医药卫生—麻醉学]