摘要
目的研究七氟烷静吸复合麻醉与丙泊酚静脉麻醉对老年冠心病(CHD)患者行腹腔镜手术围术期心脏血流动力学、心电图及术后认知功能的影响。方法选取2017年3月—2019年3月开封市中心医院拟行腹腔镜手术的老年CHD患者82例为研究对象,并采用随机数字表法均分为两组,各41例。其中七氟烷组采用七氟烷静吸复合麻醉,丙泊酚组采用丙泊酚静脉麻醉,比较两组围术期心脏血流动力学、心电图、血管活性药物应用情况及术后认知功能水平。结果两组T2、T3、T4时刻MAP和HR均较T1明显降低(P<0.05),且七氟烷组T2、T3、T4时MAP高于丙泊酚组,HR低于丙泊酚组,差异有统计学意义(P<0.05)。丙泊酚组ST-T异常发生率高于七氟烷组,差异具有统计学意义(P<0.05);丙泊酚组心律失常发生率高于七氟烷组,但差异无统计学意义(P>0.05)。七氟烷组去甲肾上腺素、阿托品及多巴胺使用率均低于丙泊酚组,差异具有统计学意义(P<0.05)。两组术后1 d和3 d时MMSE评分较术前均明显降低(P<0.05),术后7 d时MMSE评分与术前无明显差异(P>0.05);且两组各时间MMSE评分比较,差异均无统计学意义(P>0.05)。结论老年CHD患者腹腔镜手术采用七氟烷静吸复合麻醉较丙泊酚静脉麻醉更有利于维持血流动力学稳定、减轻心肌功能损害,且不明显增加认知功能损害。
Objective To investigate the effect of sevoflurane combined intravenous-inhalation anesthesia and propofol intravenous anesthesia on perioperative cardiac hemodynamics,electrocardiogram and postoperative cognitive function in elderly patients with coronary heart disease(CHD)undergoing laparoscopic surgery.Methods 82 elderly patients with CHD who underwent laparoscopic surgery in Kaifeng Central Hospital from March 2017 to March 2019 were selected and divided into two groups according to the random number table method,with 41 cases in each group.Sevoflurane group was given sevoflurane combined intravenous-inhalation anesthesia,and propofol group was given propofol intravenous anesthesia.The perioperative cardiac hemodynamics,electrocardiogram,application of vasoactive drugs and postoperative cognitive function level were compared between the two groups.Results The MAP and HR at T2,T3 and T4 in the two groups were significantly decreased compared with those at T1(P<0.05).MAP in sevoflurane group was higher than that in propofol group at T2,T3 and T4,while HR of sevoflurane group at T2,T3 and T4 was lower than that of propofol group(P<0.05).The incidence of ST-T abnormality in propofol group was higher than that in sevoflurane group,with statistical significance(P<0.05);the incidence of arrhythmia in propofol group was higher than that in sevoflurane group,but there was no statistical significance(P>0.05).The application rates of norepinephrine,atropine and dopamine in sevoflurane group were lower than those in propofol group,and the differences were statistically significant(P<0.05).The MMSE scores in the two groups at 1 d and 3 d after operation were significantly lower than those before operation(P<0.05).There was no significant difference in MMSE score at 7 d after operation between the two groups(P>0.05).There was no significant difference in MMSE score between the two groups at each time point(P>0.05).Conclusion Sevoflurane combined intravenous-inhalation anesthesia is more beneficial to maintain hemodynamic s
作者
王红
苗红玲
WANG Hong;MIAO Hongling(Department of Anesthesiology,Kaifeng Central Hospital,Kaifeng 475004,China)
出处
《中国全科医学》
CAS
北大核心
2019年第A01期145-148,共4页
Chinese General Practice
关键词
七氟烷
丙泊酚
冠心病
腹腔镜手术
Sevoflurane
Propofol
Coronary heart disease
Laparoscopic surgery
