摘要
目的:探究静吸复合麻醉对腹腔镜子宫肌瘤切除术患者应激状况、苏醒质量及认知功能的影响。方法:选取本院2020年2月-2021年9月收治的行腹腔镜子宫肌瘤切除术患者114例,简单随机法分为静脉组和复合组各57例,静脉组给予静脉全身麻醉,麻醉维持采用静脉泵注瑞芬太尼与丙泊酚;复合组给予静吸复合麻醉,麻醉维持给与静脉泵注瑞芬太尼+吸入七氟醚。比较两组麻醉诱导前(T0)、建立气腹前5min(T1)、建立气腹后5min(T2)、手术结束时(T3)血流动力学指标[心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO_(2)],麻醉苏醒质量,麻醉诱导前、手术结束时及术后2h时应激状况[皮质醇(COR)、去甲肾上腺素(NA)、血糖(Clu)],术前和术后6h、24h、48h时认知功能[简易精神状态量表(MMSE)]及药物不良反应。结果:复合组T2、T3时HR、MAP值均低于静脉组,自主呼吸恢复时间、拔管时间、苏醒时间、定向力恢复时间均低于静脉组,拔管15min、30min后Steward评分高于静脉组(均P<0.05);手术结束时、术后2h两组外周血Cor、ALD、Glu水平均高于麻醉前,但复合组均低于静脉组(P<0.05);与术前相比,两组术后MMSE评分均降低,但复合组术后6h、24h MMSE评分均高于静脉组,术后24h认知障碍发生率(3.5%)低于静脉组(14.0%)(均P<0.05);两组不良反应发生率(7.0%、10.5%)无差异(P>0.05)。结论:静吸复合麻醉可有效维持腹腔镜子宫肌瘤切除术患者的血流动力学稳定,降低应激反应和术后认知障碍发生率,患者苏醒质量较高。
Objective:To explore the effects of combined intravenous and inhalation anesthesia used during laparoscopic myomectomy of patients on their stress status,recovery quality,and cognitive function.Methods:114 patients who wanted laparoscopic myomectomy were selected and were divided into two groups(57 cases in each group)according to.the simple random method from February 2020 to September 2021.The patients in group A were given intravenous general anesthesia,and then were given intravenous pump injection of remifentanil combined with propofol for anesthesia maintenance,while the patients in group B were given com bined intravenous and inhalation anesthesia,and then were given intravenous pump injection of remifentanil combined with inhalation of sevoflurane for anesthesia mainte-nance.The hemodynamic indicators,such as heart rate(HR),mean arterial pressure(MAP),and blood oxygen saturation(SpO_(2)),before anesthesia induction(T0),at 5 min before establishment of pneumoperitoneum(T1),at 5 min after pneumoperitoneum(T2),and at the end of surgery(T3),the anesthesia recovery quality,the stress status,such as cortisol(COR)level,noradrenaline(NA)level,and blood glucose(Clu)level before anesthesia induction,at the end of surgery,and at 2h after surgery,the cognitive function by Mini-Mental State Examination(MMSE)before surgery and at 6 h,24 h,and 48 h after surgery,and the adverse drug reactions rate of the patients were compared between the two groups.Results:The values of HR and MAP of the patients in group B at T2 and T3 were significantly lower than those of the patients in group A.The spontaneous respiration recovery time,extubation time,awaking time,and orientation recovery time of the patients in group B were significantly lower than those of the patients in group A.The Steward score of the patients in group B at 15min or 30min after extubation was significantly higher than that of the patients in group A(all P<0.05).The levels of Cor,ALD,and Glu in peripheral blood of the patients in both groups at the end of surge
作者
曹文鹏
郑凯文
CAO Wenpeng;ZHENG Kaiwen(West China Guangan Hospital,Sichuan University,Gruang'an,Sichuan Province,638000)
出处
《中国计划生育学杂志》
2023年第3期527-532,共6页
Chinese Journal of Family Planning
关键词
腹腔镜子宫肌瘤切除术
静吸复合麻醉
血流动力学
应激反应
苏醒质量
认知功能
laparoscopic myomectomy
Combined intravenous and inhalation anesthesia
Haemodynamics
Stress re-action
Recovery quality
Cognitive function
