老年妇科腹腔镜手术麻醉中静吸复合麻醉与全凭静脉麻醉的效果对比

发布时间：2018-03-04 19:25

本文选题：静吸复合麻醉　切入点：全凭静脉麻醉　出处：《中国老年学杂志》2017年05期 　论文类型：期刊论文

【摘要】：目的探讨静吸复合麻醉与全凭静脉麻醉对老年妇科腹腔镜手术患者麻醉效果、血流动力学、应激反应及短期认知功能等的影响。方法 80例于全身麻醉下行妇科腹腔镜手术的患者按照麻醉方法分为静吸复合麻醉组与全凭静脉麻醉组各40例,对比两组患者麻醉效果,麻醉诱导前(T0)、诱导后(T1)、气管插管(T1)、手术结束时(T3)、收缩压(SBP)、舒张压(DBP)、心率(HR)等血流动力学指标,去甲肾上腺素、肾上腺素等应激反应指标及短期认知功能。结果静吸复合麻醉组麻醉起效时间、睁眼时间、拔管时间明显长于全凭静脉组(P0.05),静吸复合麻醉组T1、T2时SBP、DBP较T0均明显降低,全凭静脉麻醉组T1较T0明显降低,静吸复合麻醉组T1、T2、T3时HR较T0均明显提高,且T1、T2时均明显高于全凭静脉麻醉组(P0.05)。两组去甲肾上腺素T3较T0明显提高,静吸复合麻醉组肾上腺素T3较T0明显升高,且高于全凭静脉组T3,全凭静脉麻醉组T1~2较T0降低,T3较T0升高(P0.05)。麻醉诱导后24 h静吸复合麻醉组简易精神状况(MMS)评分低于全凭静脉组(P0.05),余未见明显差异。静吸复合麻醉组麻醉后6、12 h认知功能障碍发生率明显高于全凭静脉组(均P0.05)。结论静吸复合麻醉与全凭静脉麻醉应用于老年妇科腹腔镜术中均可获得显著效果,患者的血流动力学及生理指标稳定,其中全凭静脉麻醉的效果更好,生命体征更加平稳,应激反应更小,短期认知功能影响更小。
[Abstract]:Objective to investigate the anesthetic effect and hemodynamics of elderly patients undergoing laparoscopic gynecological surgery under combined intravenous anesthesia and total intravenous anesthesia. Methods 80 patients undergoing gynecological laparoscopic surgery under general anesthesia were divided into two groups according to the anesthetic methods: 40 cases in combination with intravenous anesthesia group and 40 cases in group A, and the results were compared between the two groups. Before and after anesthesia induction, hemodynamic parameters such as T0, T1, T1, T3, SBP, DBP, HRH, norepinephrine, norepinephrine, etc. Results the onset time, eye opening time and extubation time in the combined anesthesia group were significantly longer than those in the total intravenous group (P 0.05), and SBP + DBP in the combined intravenous anesthesia group was significantly lower than that in the T _ 0 group at T _ 1 and T _ 2. T1 of total intravenous anesthesia group was significantly lower than that of T0 group, HR of T1 + T2 + T3 group was significantly higher than that of T0 group, and T _ 1 / T _ 2 was significantly higher than that of total intravenous anesthesia group (P0.05), and norepinephrine T3 was significantly higher in both groups than that in T0 group. Compared with T0, the adrenaline T3 level was significantly higher in the intravenous inhalation combined anesthesia group. It was higher than T3 in total intravenous anesthesia group, and T _ 1n _ 2 was lower than T _ 0 in total intravenous anesthesia group, and T _ 3 was higher than T _ 0. The score of simple mental state in combined anesthesia group 24 hours after anesthesia induction was lower than that in total intravenous anesthesia group (P _ (0.05)), but there was no significant difference between intravenous anesthesia group and total intravenous anesthesia group. The incidence of cognitive dysfunction in the anesthetic group was significantly higher than that in the total intravenous group at 6 and 12 hours after anesthesia (all P 0.05). Conclusion both intravenous anesthesia and intravenous anesthesia can achieve significant results in the elderly gynecological laparoscopic surgery. The hemodynamic and physiological indexes of the patients were stable, in which the effect of total intravenous anesthesia was better, the vital signs were more stable, the stress response was less, and the effect of short-term cognitive function was less.
【作者单位】：重庆市中医院麻醉科;重庆市中医院妇产科;
【基金】：重庆市卫生计生委医学科研计划项目(No.20142068)
【分类号】：R614.2

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