依托咪酯和丙泊酚对老年患者腹腔镜胆囊切除术后认知功能障碍的影响

发布时间：2018-04-20 16:09

本文选题：依托咪酯 + 丙泊酚　；参考：《中国药房》2015年23期

【摘要】：目的:探讨在全身麻醉中,依托咪酯和丙泊酚对老年患者腹腔镜胆囊切除术(LC)后早期认知功能障碍(POCD)的影响及血清S100β蛋白对早期POCD发生的意义。方法:选择年龄65岁、在喉罩通气全身麻醉下行LC的患者60例,采用随机数字表法分为依托咪酯组(E组)和丙泊酚组(P组),每组30例。麻醉诱导为静脉注射依托咪酯0.3mg/kg(E组)或丙泊酚1.5mg/kg(P组),另加舒芬太尼0.4μg/kg、维库溴铵0.12mg/kg。麻醉维持为静脉泵入瑞芬太尼0.15μg/(kg·min),持续靶控输注依托咪酯(靶浓度1.0~1.5μg/ml)(E组)或丙泊酚(靶浓度3.0~4.0μg/ml)(P组),通过调整依托咪酯或丙泊酚靶浓度,维持脑电双频指数(BIS)为40~50。于术前1 h(T0)、术后2 h(T1)、术后24 h(T2)及术后48 h(T3)分别抽取患者动脉血,检测S100β蛋白含量并记录简易智力状态检查(MMSE)评分,同时观察并记录两组患者苏醒时间、拔除喉罩时间、麻黄碱用量及术中知晓情况。结果:两组患者各时点MMSE评分组间比较差异无统计学意义(P0.05);两组患者T1和T2时的MMSE评分均明显低于T0时,差异有统计学意义(P0.05)。两组患者各时点S100β蛋白含量组间比较差异无统计学意义(P0.05);两组患者T1和T2时的S100β蛋白含量均明显高于T0时,差异有统计学意义(P0.05)。两组患者苏醒时间和拔除喉罩时间均较短,差异无统计学意义(P0.05);P组患者麻黄碱用量明显多于E组,差异有统计学意义(P0.05)。两组患者术后随访均无术中知晓发生。结论:依托咪酯和丙泊酚全身麻醉均可安全地用于老年患者LC,均能引起不同程度的短暂POCD。血清S100β蛋白含量与早期POCD的发生有一定相关性。
[Abstract]:Objective: To investigate the effect of etomidate and propofol on early cognitive dysfunction (POCD) after laparoscopic cholecystectomy (LC) in elderly patients and the significance of serum S100 beta protein to early POCD. Methods: selecting 60 cases of LC in the patients aged 65 years and undergoing general anesthesia with laryngeal mask ventilation. The group (group E) and propofol group (group P), 30 cases in each group, were induced by intravenous injection of etomidate 0.3mg/kg (group E) or propofol 1.5mg/kg (P group), plus sufentanil 0.4 g/kg, and vecuronium 0.12mg/kg. anesthesia maintained as intravenous infusion of remifentanil 0.15 u g/ (kg. Min), and targeted infusion of etomidate (target concentration 1.0~1.5 Muu) Or propofol (target concentration 3.0~4.0 mu g/ml) (group P), by adjusting the target concentration of etomidate or propofol, the EEG bispectral index (BIS) was maintained at 1 h (T0) before operation, 2 h (T1) after operation, 24 h (T2) after operation and 48 h after operation respectively. And recorded two groups of patients' awakening time, extraction of laryngeal mask time, ephedrine dosage and intraoperative awareness. Results: there was no significant difference between the two groups at each time point MMSE score group (P0.05); the two groups of patients with T1 and T2 were significantly lower than T0, the difference has the significance of overall planning (P0.05). The content of S100 beta protein at each time point of the two groups of patients. There was no significant difference between groups (P0.05). The S100 beta protein content of T1 and T2 in the two groups was significantly higher than that of T0 (P0.05). The time of awakening and the extraction of larynx were shorter in the two groups (P0.05), and the dosage of ephedrine in P group was significantly more than that in the E group (P0.05), and the difference was statistically significant (P0.05). The two groups of patients were followed up without intraoperative awareness. Conclusion: the general anesthesia of etomidate and propofol can be safely used in the elderly patients with LC, which can cause a certain correlation between the content of S100 beta protein in different degrees of transient POCD. serum and the occurrence of early POCD.

【作者单位】：西安交通大学医学院第二附属医院麻醉科;榆林市第一医院麻醉科;
【基金】：榆林市科技计划项目(No.2014jh-20)
【分类号】：R614

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