静脉快通道麻醉用于老年患者胆囊切除术的临床观察

Application of Intravenous Fast-Tracking Anesthesia in Elderly Patients Undergoing Cholecystectomy

目的观察静脉快通道麻醉与吸入麻醉对老年胆囊切除术患者术后苏醒、血糖、皮质醇的影响。方法100例择期行胆囊切除术的老年患者,ASA分级Ⅰ～Ⅱ级,随机分为A组(静脉全麻组)、B组(吸入麻醉组),每组50例。所有病人常规诱导后气管插管,A组麻醉维持以微泵持续注射丙泊酚60～120μg.(kg.min)-1、瑞芬太尼0.05～2μg.(kg.min)-1。B组麻醉维持采用0.5%～2%安氟醚持续吸入。两组术中均间断追加顺式阿曲库铵。手术结束后采用Steward麻醉苏醒评分法,10min内评分在4分及以上者送回病房,否则送入PACU;分别于诱导前、切皮后30min、术毕、手术后1h抽取静脉血测定血糖及血浆皮质醇浓度,记录两组患者的拔管时间以及术后恶心呕吐的发生情况。结果 A组患者10min内Steward评分在4分及其以上者42例,B组31例,A组多于B组(P<0.05);A组患者术后恶心呕吐者10例(20%),B组24例(48%),A组低于B组(P<0.01);两组诱导后各时点血糖和皮质醇水平组间比较差异有统计学意义(P<0.05);血糖:与诱导前比较A组和B组各时间点均升高(P<0.01),波动幅度A组较B组小;皮质醇:与诱导前比较,A组在各时间点均有轻度升高,但差异均无统计学意义(P>0.05),而B组各时间点均有明显升高(P<0.01)。结论静脉快通道麻醉可让胆囊切除术的老年病人术后尽早苏醒,降低术后恶心呕吐发生率,且对血糖和皮质醇的影响较吸入麻醉轻微。

Objective To investigate the effect of fast-tracking anesthesia and inhaled anesthesia on recovery and blood glucose,cortisol in elderly patients undergoing cholecystectomy.Methods 100 eldly patients scheduled for elective cholecystectomy with ASA physical status Ⅰ~Ⅱ were randomly divided into two groups:total intravenous anesthesia group(A) and inhalation anesthesia group(B).All patients routinely induced by tracheal intubation.Anesthesia was maintained with propofol 60~120μg·(kg·min)-1and remifentanil 0.05~2μg·(kg·min)-1in group A.Anesthesia was maintained with 0.5%~2% enflurane sustained inhalation in group B.The two groups took cis-atracurium discontinuously.The patients were scored using Steward postanesthesia recovery score system after operation completed.Patients with scores of 4 or higher within 10min were transferrd to the ward,otherwise recovered in PACU.The cortisol and blood glucose were recorded before anesthesia induction,30 minutes after the beginning of operation,the end of operation and an hour after operation.Post operative nausea,vomiting(PONV)and other postoperative complications were recorded.Results 42 patients scored 4 or higher within 10min in A group were transferred to the ward and 31 in B group(P&lt;0.05).Incidence of PONV was 20%(10) in A group and 48%(24) in B group(P&lt;0.01).Blood glucose and cortisol after the induction time bwtween two groups showed significant difference(P&lt;0.05).Conclusion Intravenous fast-tracking anesthesia could get a rapid recovery and reduce the incidence of PONV.Effects of intravenous fast-tracking anesthesia on blood glucose and cortisol were lighter than those of inhalation anesthesia.