依托咪酯与丙泊酚对颅内动脉瘤介入治疗患者认知功能及脑损伤程度的影响  

Effects of etomidate and propofol on cognitive function and brain injury in intracranial aneurysm interventional therapy

作　　者：边兴花 许鹏 Bian Xinghua;Xu Peng(The First Hospital of Zhangjiakou City in Hebei Province,Zhangjiakou Hebei 075000,China)

机构地区：[1]河北省张家口市第一医院,河北张家口075000

出　　处：《中国医刊》2024年第7期759-763,共5页Chinese Journal of Medicine

基　　金：河北省科技计划项目(20181173)。

摘　　要：目的比较依托咪酯与丙泊酚对颅内动脉瘤介入治疗患者认知功能及脑损伤程度的影响。方法选取2021年8月至2023年8月河北省张家口市第一医院收治的98例行介入治疗的颅内动脉瘤患者为研究对象,在组间基线特征可比的原则上,采用随机数字表法分为对照组和观察组,每组49例。对照组麻醉诱导和麻醉维持时给予丙泊酚注射液,观察组麻醉诱导和麻醉维持时给予依托咪酯注射液。比较分析两组患者的围手术期相关指标,术前以及术后3、7 d的认知功能[简易精神状态检查量表(MMSE)],麻醉诱导前(T_(0))、气管插管后5 min(T_(1))、手术开始时(T_(2))、手术结束时(T_(3))的血流动力学水平[平均动脉压(MAP)、心率(HR)、收缩压(SBP)、舒张压(DBP)]。比较分析两组患者术前、术后3 d的炎症反应及脑损伤程度[肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、诱导型一氧化氮合酶(iNOS)、神经元特异性烯醇化酶(NSE)]以及术后不良反应发生情况。结果观察组患者的意识消失时间、自主呼吸恢复时间均短于对照组,差异有统计学意义(P<0.05)。术前,两组患者的MMSE评分比较差异无统计学意义(P>0.05);术后3、7 d,两组患者的MMSE评分与术前比较均降低,但观察组高于对照组,差异均有统计学意义(P<0.05)。T_(0)时刻,两组患者的MAP、HR、SBP、DBP比较差异均无统计学意义(P>0.05);T_(1)、T_(2)、T_(3)时刻,两组患者的MAP、SBP、DBP与T_(0)时刻比较均降低,但观察组高于对照组,差异均有统计学意义(P<0.05)。术前,两组患者的TNF-α、IL-6、iNOS、NSE水平比较差异均无统计学意义(P>0.05);术后3 d,两组患者的TNF-α、IL-6、iNOS、NSE水平与术前比较均升高,但观察组低于对照组,差异均有统计学意义(P<0.05)。两组患者的术后不良反应总发生率比较差异均无统计学意义(P>0.05)。结论与丙泊酚比较,依托咪酯可显著改善颅内动脉瘤介入治疗患者的Objective To compare the effects of etomidate and propofol on cognitive function and brain injury in intracranial aneurysm interventional therapy.Method A total of 98 patients with intracranial aneurysms undergoing interventional treatment admitted to the First Hospital of Zhangjiakou City in Hebei Province from August 2021 to August 2023 were selected as the study objects.They were divided into control group and observation group by random number table method based on the principle of comparison of baseline features between groups,with 49 cases in each group.The control group was given propofol injection during anesthesia induction and maintenance,and the observation group was given etomidate injection during anesthesia induction and maintenance.The perioperative relevant indexes,cognitive function(MMSE scores)before and 3 and 7 days after surgery,Hemodynamic levels(MAP,HR,SBP,DBP)before anesthesia induction(T_(0)),5 min after tracheal intubation(T_(1)),at the beginning of surgery(T_(2)),and at the end of surgery(T_(3))were compared between the two groups.The inflammatory response and the degree of brain injury(TNF-α,IL-6,iNOS,NSE)before and 3 days after surgery and the occurrence of postoperative adverse reactions were compared between the two groups.Result The loss time of consciousness and recovery time of spontaneous respiration in observation group were shorter than those in control group,and the differences were statistically significant(P<0.05).Before surgery,there were no significant differences in MMSE scores between the two groups(P>0.05).At 3 and 7 days after surgery,MMSE scores in two groups were decreased than those before surgery,but the observation group was higher than the control group,with statistical significance(P<0.05).At T_(0),there were no significant differences in MAP,HR,SBP and DBP between the two groups(P>0.05).At T_(1),T_(2) and T_(3),MAP,SBP and DBP in two groups were decreased than those at T_(0),but the observation group was higher than the control group,with statistical significa

关 键 词：颅内动脉瘤 介入治疗 依托咪酯 丙泊酚 认知功能 脑损伤 

分 类 号：R614[医药卫生—麻醉学]