摘要
目的：观察七氟醚联合丙泊酚对老年患者腹腔镜胆囊切除术后早期认知功能的影响。方法：将72例行腹腔镜胆囊切除术的老年患者均分为对照组和观察组。对照组患者采用靶控静脉注射模式于术中静脉持续泵入顺苯磺酸阿曲库铵0.1 mg/（kg·h）并维持肌肉松驰,静脉＋吸入丙泊酚共2 mg/kg。观察组患者在对照组给药的基础上联合给予七氟醚,呼气末浓度1.0%~2.0%。两组患者均在切皮前追加枸橼酸芬太尼注射液2μg/kg,术中每小时追加枸橼酸芬太尼注射液2μg/kg;脑电双频指数（BIS）监测麻醉深度,并根据检测结果对七氟醚的浓度和丙泊酚剂量进行控制,使BIS控制在40~60。观察两组患者入室时（T0）、插管后（T1）、切皮时（T2）、关腹时（T3）、拔管时（T4）的心率（HR）、平均动脉压（MAP）、血氧饱和度（Sp O2）及术后苏醒时间,术前及术后第1、2、7天神经精神功能指标和术后认知功能障碍发生率,并记录不良反应发生情况。结果：对照组患者T2时MAP显著高于同组其他时间点;观察组患者T1时MAP显著低于同组其他时间点,且观察组显著低于对照组（P〈0.05）。两组患者术后苏醒时间比较,差异无统计学意义（P〉0.05）。两组患者术后第1、3天除循迹连线指标显著高于同组术前、观察组高于对照组（P〈0.05）外,其他指标均显著低于同组术前,且观察组低于对照组（P〈0.05）。观察组患者术后认知功能障碍发生率显著低于对照组（P〈0.05）。两组患者给药期间均未见明显不良反应发生。结论：七氟醚联合丙泊酚静脉麻醉较单用丙泊酚可更有效地改善老年患者腹腔镜胆囊切除术后早期认知功能,安全性较好。
OBJECTIVE：To observe the effect of sevoflurane combined with propofol on early cognitive function of elderly patients after laparoscopic cholecystectomy. METHODS：A total of 72 cases with laparoscopic cholecystectomy were divided into control group and observation group. Patients in the control group were given continuous intravenous pumping cisatracurium besilate during operation（for injection）0.1 mg/（kg·h）by target controlled intravenous（TCI）mode to maintain muscle relaxation,intravenous and inhalation anesthesia propofol 2 mg/kg. The observation group was administered composite intravenous and inhalation anesthesia sevoflurane in the concentration of 1.0%-2% on the basis of control group. 2 groups were given fentanyl citrate injection2 μg/kg before skin incision,additional a fentanyl citrate injection 2 μg/kg per hour intraoperatively. The depth of anesthesia was monitored by BIS the bispectral index,and the concentration of sevoflurane and propofol dose was detected and controued according to the result to ensure BIS was in 40-60. 2 groups were observed in respects of the heart rate（HR）,mean arterial pressure（MAP）,saturation of blood oxygen（Sp O2）,postoperative recovery time,neuropsychiatric function index before and after operation 1 d,2 d and 7 d,incidence of postoperative cognitive dysfunction in burglary（T0）,after intubation（T1）,skin incision（T2）,abdomen closed（T3）and extubation（T4）. The occurrence of adverse reaction was recorded. RESULTS：MAP in the control group in T2 was higher than the same group in other time points（P〈0.05）;MAP in observation group in T1 was lower than the same group in other time points,and observatior group was lower than control group（P〈0.05）,There was no significant difference in the postoperative recovery time in 2 groups（P〉0.05）. The index after 1 d and 3 d were significantly higher than before treatment except for tracking connection index,and observation group was higher than control group（P〈0.05）;the others were all significantly lower than before,and observation group was lower than control group（P〈0.05）. There was no significant difference in neuropsychiatric function index after 7 days（P〈0.05）. The incidence of postoperative cognitive dysfunction in observation group was lower than control group（P〈0.05）. There were no obvious adverse reactions during treatment. CONCLUSIONS：Sevoflurane combined with propofol can more effectively improve the early cognitive function of elderly patients after laparoscopic cholecystectomy with better safety.
出处
《中国药房》
CAS
北大核心
2015年第9期1167-1169,共3页
China Pharmacy
关键词
腹腔镜胆囊切除术
静脉麻醉
吸入麻醉
术后认知功能
Laparoscopic cholecystectomy
Intravenous anesthesia
Inhalation anesthesia
Postoperative cognitive function
作者简介
主治医师。研究方向：临床麻醉。电话：0818—2386606
