丙泊酚与瑞芬太尼静吸复合麻醉对老年腹腔镜下胆囊切除患者术后认知功能的影响

发布时间：2018-07-11 11:20

本文选题：腹腔镜胆囊切除术 + 老年患者　；参考：《医学综述》2016年10期

【摘要】：目的探讨丙泊酚与瑞芬太尼静吸复合麻醉对老年腹腔镜下胆囊切除患者术后认知功能的影响。方法选择2014年2~12月上海市交通大学附属同仁医院治疗的90例行腹腔镜下胆囊切除术的老年患者为研究对象,按抽签法随机分为观察组和对照组,各45例。观察组患者采用丙泊酚与瑞芬太尼静脉麻醉复合吸入进行麻醉(1.5~2.5 mg/kg丙泊酚、2μg/kg的瑞芬太尼以及0.1 mg/kg维库溴铵),对照组则采用丙泊酚与瑞芬太尼靶控静脉麻醉(瑞芬太尼血浆靶的浓度设置为4.0μg/L,丙泊酚血浆靶浓度设置为3.5 mg/L)。比较两组患者在治疗中的拔管时间、手术时间以及苏醒时间等基本情况,比较两组患者手术前后的简易精神状态评价量表(MMSE)评分、警觉-镇静评分(OAAS),术后调查分析两组患者对治疗中麻醉情况的满意度。结果观察组患者苏醒时间、自主恢复呼吸时间以及定向力恢复时间均短于对照组[(6.4±2.6)min比(7.7±2.3)min,(2.4±0.9)min比(6.2±1.3)min,(8.8±2.5)min比(11.7±3.1)min],差异有统计学意义(P0.05)。对照组在术后1 h、3 h、1 d的MMSE评分表现为先下降后升高的趋势,而观察组在术后1 h、3 h、1 d的MMSE评分无明显变化,观察组患者在拔管后1 h、3 h以及1 d的评分均高于对照组,差异有统计学意义(P0.05)。两组患者在术后即刻、术后1 h及术后3 h的OAAS评分均呈上升趋势,观察组各时间点均高于对照组,差异有统计学意义(P0.05)。观察组患者的总满意度高于对照组[97.8%(44/45)比84.4%(38/45)],差异有统计学意义(P0.05)。结论老年腹腔镜下胆囊切除术应用丙泊酚与瑞芬太尼静吸复合麻醉,对患者术后认知功能影响较小,麻醉恢复时间短,值得推广应用。
[Abstract]:Objective to investigate the effect of propofol and remifentanil combined anesthesia on cognitive function of elderly patients undergoing laparoscopic cholecystectomy. Methods 90 elderly patients who were treated with laparoscopic cholecystectomy in Tongren Hospital affiliated to Shanghai Jiaotong University from February to December 2014 were randomly divided into observation group (n = 45) and control group (n = 45). Patients in the observation group were anesthetized by intravenous anesthesia of propofol and remifentanil (remifentanil 2 渭 g/kg of 1.5 mg/kg and vecuronium 0. 1 mg/kg), while those in the control group were anesthetized by target controlled intravenous anesthesia with propofol and remifentanil (remifene). The target concentration of ternitine was 4.0 渭 g / L, and that of propofol was 3.5 mg / L. The extubation time, operation time and recovery time were compared between the two groups, and the MMSE scores before and after operation were compared between the two groups. Alertness-sedation score (OAAS) was used to investigate the patients' satisfaction with anesthesia after operation. Results the recovery time, spontaneous recovery time and directional recovery time in the observation group were significantly shorter than those in the control group [(6.4 卤2.6) min vs (7.7 卤2.3) min, (2.4 卤0.9) min vs (6.2 卤1.3) min, (8.8 卤2.5) min vs (11.7 卤3.1) min] (P0.05). The MMSE scores of the control group decreased first and then increased at 1 hour and 3 hours after operation, while the MMSE scores of the observation group showed no significant change at 1 hour or 3 hours after extubation. The MMSE scores in the observation group were higher than those in the control group at 1 hour and 1 day after extubation. The MMSE scores in the observation group were higher than those in the control group at 1 hour and 1 day after extubation. The difference was statistically significant (P0.05). The OAAS scores of the two groups showed an upward trend immediately after operation 1 hour and 3 hours after operation. The OAAS scores in the observation group were higher than those in the control group at each time point the difference was statistically significant (P0.05). The total satisfaction of patients in the observation group was significantly higher than that in the control group [97.8% (44 / 45) vs 84.4% (38 / 45)] (P0.05). Conclusion the combined anesthesia of propofol and remifentanil in elderly laparoscopic cholecystectomy has little effect on postoperative cognitive function and short recovery time, so it is worth popularizing.
【作者单位】：上海市交通大学附属同仁医院麻醉科;
【分类号】：R614

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