摘要
目的比较单用依托咪酯与舒芬太尼复合依托咪酯在骨科高龄患者手术麻醉中的应用效果及对术中应激反应、认知功能的影响。方法选取2019年6月至2020年6月于宁德师范学院附属宁德市医院骨科拟行全身麻醉手术治疗的92例高龄患者作为研究对象。采用随机数字表法将其分为对照组(n=45)与联合组(n=47)。对照组行依托咪酯传统麻醉诱导,联合组采用舒芬太尼联合依托咪酯进行麻醉,比较两组麻醉效果及各时相血流动力学参数变化、术中应激反应、术后苏醒相关指标、认知功能情况与术后不良反应情况。结果T_(0)时两组收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)比较,差异无统计学意义(P>0.05),T_(1)、T_(2)、T_(3)、T_(4)、T_(5)时对照组SBP、DBP、MAP、HR较T_(0)时均明显降低,差异有统计学意义(P<0.05),但均在临床安全范围内,而联合组给药后各时相SBP、DBP、MAP、HR水平比较,差异无统计学意义(P>0.05)。两组T_(0)时血浆肾上腺素(E)、去甲肾上腺素(NE)浓度比较,差异无统计学意义(P>0.05),T_(1)及T_(5)时血浆E、NE水平较术前明显升高,差异有统计学意义(P<0.05),但联合组T_(1)及T_(5)时血浆E、NE水平明显低于对照组,差异有统计学意义(P<0.05)。术后联合组睁眼时间、拔管时间、定向力恢复时间略低于对照组,但差异无统计学意义(P>0.05)。术前两组简易智力状态检查量表(MMSE)、临床记忆量表(MQ)评分比较,差异无统计学意义(P>0.05),术后12 h时联合组MMSE、MQ评分较术前有所降低,差异无统计学意义(P>0.05),对照组术后12 h时MMSE、MQ评分较术前明显降低,差异有统计学意义(P<0.05),并且联合组术后12 h时MMSE、MQ评分明显高于对照组,差异有统计学意义(P<0.05)。术后联合组患者不良反应总发生率明显低于对照组,差异有统计学意义(P<0.05)。结论骨科高龄患者全身麻醉术中舒芬太尼复合依托咪酯麻醉诱导较单用依托咪酯能够更为有效地抑制术中插管引起的应激反应,对全身麻醉诱导期患者血流动力学指标影响较小,且可有效降低认知功能障碍发生风险,具有应用及推广价值。
Objective To compare the effects of etomidate alone with sufentanil combined with etomidate on operative anesthesia,intraoperative stress response and cognitive function in elderly orthopedic patients.Methods A total of 92 elderly patients who were to be treated with general anesthesia in the department of anesthesiology in Ningde Municipal Hospital Affiliated to Ningde Normal University from June 2019 to June 2020 were selected as the study subjects.They were divided into the control group(n=45)and the combined group(n=47)by using the random number table method.The control group underwent traditional anesthesia induction with etomidate,while the combined group underwent anesthesia with sufentanil combined with etomidate.The anesthetic effects and changes of hemodynamic parameters in each time phase,intraoperative stress response,postoperative analepsia indicators,cognitive function and postoperative adverse reactions were compared between the two groups.Results There were no statistically significant differences in systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP)and heart rate(HR)between the two groups at T_(0)(P>0.05).SBP,DBP,MAP,and HR in the control group at T_(1),T_(2),T_(3),T_(4),and T5 were significantly lower than those at T_(0),with statistically significant differences(P<0.05),but they were all within the scope of clinical safety.However,there were no statistically significant differences in SBP,DBP,MAP,and HR in each time phase after drug administration in the combined group(P>0.05).In addition,there were no statistically significant differences in plasma epinephrine(E)and norepinephrine(NE)levels between the two groups at T_(0)(P>0.05).Meanwhile,the plasma E and NE levels in the two groups at T_(1)and T5 were significantly higher than those before the operation,with statistically significant differences(P<0.05).And the plasma E and NE levels in the combined group at T_(1)and T5 were significantly lower than those in the control group,with statistically significant differences(P<0.05).After operation,the eye-opening time,extubation time,and recovery time of orientation in the combined group were slightly shorter than those in the control group,without statistically significant differences(P>0.05).Before operation,there were no statistically significant differences between the two groups in the scores of Mini-Mental State Examination(MMSE)Scale and Clinical Memory(MQ)Scale(P>0.05).At 12 h after operation,the scores of MMSE and MQ in the combined group were lower than those before operation,but without statistically significant differences(P>0.05).While the scores of MMSE and MQ in the control group at 12 h after operation were significantly lower than those before operation,with statistically significant differences(P<0.05).And the scores of MMSE and MQ in the combined group at 12 h after operation were significantly higher than those in the control group,with statistically significant differences(P<0.05).The total incidence of adverse reactions in the combined group was significantly lower than that in the control group after operation,with statistically significant difference(P<0.05).Conclusion In general anesthesia for elderly orthopedic patients,the induction of sufentanil combined with etomidate anesthesia is more effective than etomidate alone in inhibiting the stress response caused by intubation during the operation.It has less impact on the hemodynamic indices of patients during the induction period of general anesthesia,and can effectively reduce the risk of cognitive dysfunction.therefore,it is worthy of application and promotion.
作者
朱艺霞
王明虹
徐曈
ZHU Yixia;WANG Minghong;XU Tong(Department of Anesthesiology,Ningde Municipal Hospital Affiliated to Ningde Normal University,Fujian,Ningde 352100,China)
出处
《中国医药科学》
2022年第1期144-148,共5页
China Medicine And Pharmacy
关键词
舒芬太尼
依托咪酯
骨科高龄患者手术
血流动力学参数
术中应激反应
认知功能障碍
Sufentanil
Etomidate
Operation for elderly orthopedic patients
Hemodynamic parameters
Intraoperative stress response
Cognitive dysfunction
