依托咪酯复合瑞芬太尼麻醉诱导对老年腹腔镜手术患者术后认知功能的影响

发布时间：2019-03-19 19:46

【摘要】：目的观察依托咪酯复合瑞芬太尼麻醉诱导对老年腹腔镜手术患者术后早期认知功能的影响。方法拟行腹腔镜手术的老年(年龄60岁)患者180例,将其随机分为依托咪酯组、瑞芬太尼组和联合组各60例。依托咪酯组采用靶控输注(TCI)依托咪酯进行麻醉诱导,血浆靶浓度0.4 mg/L;瑞芬太尼组TCI瑞芬太尼,血浆靶浓度2.0 ng/m L;联合组TCI瑞芬太尼2.0 ng/m L、依托咪酯0.1~0.3 mg/kg。各组术中均以芬太尼4μg/kg和阿曲库铵0.15 mg/(kg·h)持续泵入维持麻醉。记录各组手术时间和睁眼时间。分别于术前1天及术后1、12、24、48、72 h进行简易智能量表(MMSE)评分,分别于术前1天及术后1、3、5天进行韦氏评分量表(WAIS)评分。结果联合组手术时间短于依托咪酯组、瑞芬太尼组,睁眼时间长于依托咪酯组、瑞芬太尼组(P均0.05)。3组术后1、12、24 h MMSE评分均低于术前(P均0.05);联合组术后48、72 h MMSE评分高于依托咪酯组、瑞芬太尼组(P均0.05)。3组术后1、3、5天WAIS评分均低于术前(P均0.05);联合组术后3、5天WAIS评分高于依托咪酯组、瑞芬太尼组(P均0.05)。结论对于行腹腔镜手术的老年患者,采用依托咪酯复合瑞芬太尼麻醉诱导对患者术后认知功能影响较小,优于单药应用。
[Abstract]:Objective to observe the effect of etomidate combined with remifentanil anesthesia on early cognitive function in elderly patients undergoing laparoscopic surgery. Methods 180 elderly patients (60 years old) undergoing laparoscopic surgery were randomly divided into etomidate group (n = 60), remifentanil group (n = 60) and combined group (n = 60). Etomidate group was induced by target controlled infusion of etomidate (TCI). Plasma target concentration of remifentanil was 0.4 mg/L; and plasma target concentration of TCI remifentanil was 2.0 ng/m / L in remifentanil group. Combined group TCI remifentanil 2.0 ng/m L, etomidate 0.1 / 0.3 mg/kg. Fentanyl 4 渭 g / kg and atracurium 0.15 mg/ (kg 路h) were used to maintain anesthesia. The operation time and eye opening time were recorded in each group. One day before operation and 1,12,24,48,72 hours after operation, the simplified Intelligence scale (MMSE) was evaluated. The (WAIS) score of Wechsler scale was performed on the first day before the operation and 1,3,5 days after the operation. The patients were divided into two groups: 1 day before operation and 1 day, 3 days and 5 days after operation. Results the operation time in the combined group was shorter than that in the etomidate group, remifentanil group and remifentanil group, and the MMSE scores in the three groups were lower than those before operation at 1,12,24 hours after operation (all P 0.05), and that in the remifentanil group was longer than that in the etomidate group and remifentanil group. The MMSE scores in the combined group were higher than those in the etomidate group and remifentanil group at 48,72 hours after operation, and the WAIS scores in the three groups were lower than those before operation at 1, 3 and 5 days after operation (all P 0.05). The WAIS scores in the combined group were higher than those in the etomidate group and remifentanil group on the 3rd and 5th day after operation. Conclusion Etomidate combined with remifentanil anesthesia induction has little effect on cognitive function in elderly patients undergoing laparoscopic surgery, which is superior to single drug application.
【作者单位】：陕西煤化集团铜川矿务局中心医院;
【分类号】：R614.2

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