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

发布时间：2018-06-14 12:44

本文选题：腹腔镜胆囊切除术 + 静脉麻醉　；参考：《中国药房》2015年09期

【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(P0.05)。两组患者术后苏醒时间比较,差异无统计学意义(P0.05)。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(P0.05)外,其他指标均显著低于同组术前,且观察组低于对照组(P0.05)。观察组患者术后认知功能障碍发生率显著低于对照组(P0.05)。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。
[Abstract]:Objective: To observe the effect of sevoflurane combined with propofol on the early cognitive function of the elderly patients after laparoscopic cholecystectomy. Methods: 72 cases of elderly patients with laparoscopic cholecystectomy were divided into the control group and the observation group. The control group used the target intravenous injection mode in the intraoperative intravenous infusion of atracurium 0.1 mg/ (atraconium sulfonate). Kg. H) and maintain muscle relaxation, intravenous + inhaled propofol 2 mg/kg. observation group of patients in the control group on the basis of the combination of sevoflurane on the basis of the control group, the end expiratory concentration 1.0%~2.0%. two groups were added Fentanyl Citrate Injection 2 mu g/kg, 2 mu per hour during the operation, and the EEG double frequency index (BIS). ) monitoring the depth of anesthesia, and controlling the concentration of sevoflurane and the dose of propofol according to the results of the test, so that BIS was controlled by 40~60. in two groups of patients (T0), after intubation (T1), skin cutting (T2), ventral closure (T3), heart rate (HR), mean arterial pressure (MAP), oxygen saturation (Sp O2) and postoperative recovery time, before and after first. The 2,7 day nerve mental function index and the incidence of postoperative cognitive dysfunction and the incidence of adverse reactions were recorded. Results: the control group was significantly higher than the same group of other time points at the time of T2, while the MAP in the observation group was significantly lower than the other time points in the same group, and the observation group was significantly lower than the control group (P0.05). The two groups of postoperative recovery time compared to the two groups. The difference between the two groups was significantly higher than that of the same group before operation (P0.05). The observation group was significantly lower than the control group (P0.05), and the other indexes were significantly lower than the same group, and the observation group was lower than the control group (P0.05). The incidence of cognitive dysfunction in the observation group was significantly lower than that of the control group (P0.05). Two Conclusion: sevoflurane combined with propofol and propofol can better improve the early cognitive function after laparoscopic cholecystectomy in elderly patients with better safety.
【作者单位】：达州市中心医院住院部麻醉科;
【分类号】：R614.2

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