舒芬太尼复合丙泊酚或七氟烷麻醉对二氧化碳气腹老年患者应激反应及苏醒质量的影响

Effects of Sufentanil-propofol and Sufentanil-sevoflurane on Stress Response and Anesthetic Recovery in Elderly Patients Undergoing CO_2 Pneumoperitoneum

目的评价舒芬太尼复合丙泊酚或七氟烷麻醉对行腹腔镜胆囊切除术老年患者的应激反应及苏醒质量的影响。方法择期行腹腔镜胆囊切除术患者40例,性别不限,年龄60～75岁,ASAⅠ或Ⅱ级,均全身麻醉使用喉罩（Supreme-LMA）管理气道。随机分为舒芬太尼复合丙泊酚组（P组）和舒芬太尼复合七氟烷组（S组）。于入室（T0）、气腹前（T1）、气腹20 min（T2）、术毕拔管后5 min（T3）记录平均动脉压和心率,并检测各时点血浆促肾上腺皮质激素、皮质醇、去甲肾上腺素和肾上腺素浓度,同时记录2组患者自主呼吸恢复时间、呼之睁眼时间、意识完全清醒时间、拔管时间及Steward苏醒评分。结果 2组平均动脉压和心率均在正常范围内。与T0时点比较,T1和T3时点2组皮质醇和去甲肾上腺素浓度的差异无统计学意义（P〉0.05）;T2时点,P组平均动脉压和心率明显降低,S组平均动脉压和心率升高,并且P组促肾上腺皮质激素、皮质醇、肾上腺素和去甲肾上腺素浓度降低,S组皮质醇、肾上腺素和去甲肾上腺素浓度明显升高,2组的差异有统计学意义（P〈0.05）;T3时点2组促肾上腺皮质激素和肾上腺素变化程度的差异有统计学意义（P〈0.05）。2组自主呼吸恢复时间、呼之睁眼时间、意识完全清醒时间、拔管时间及Steward苏醒评分的差异无统计学意义（P〉0.05）。结论腹腔镜胆囊切除术中应用舒芬太尼复合丙泊酚麻醉能较好的抑制老年患者的应激反应,并且对苏醒质量没有明显影响。

Objective To investigate the effects of sufentanil-propofol and sufentanil-sevoflurane on stress response and anesthetic recovery in elderly patients undergoing laparoscopic cholecystectomy（LC）.Methods Forty ASA Ⅰ or Ⅱ patients,male or female,aged 60-75 years,using the Supreme-LMA management airway for general anesthesia during LC,were randomly divided into two groups（n = 20）：sufentanil-propofol group（group P） and sufentanil-sevoflurane group（group S）.MAP and HR were recorded separately at different time points as follows：after entering the operating room（T0）,the time before pneumoperitoneum（T1）,20 min after pneumoperitoneum（T2） and 5 min after extubation（T3）.Venous blood samples were taken at T0-T3 to determine the concentrations of adrenocorticotrophichormone（ACTH）,cortisol（Cor）,epinephrine（E） and norepinephrine（NE） in plasma.Also,the recovery time of spontaneous respiration,eye-open after called,the awake time of consciousness,extubation time and Steward score were recorded.Results The MAP and HR were maintained in the normal range during operation in both groups.Compared with at T0,there was no significant difference of Cor or NE concentration in plasma at T1,T3 in neither group P nor group S（P 0.05）;MAP and HR were significantly decreased in group P but increased in group S;plasma ACTH,Cor,E and NE were significantly decreased in group P while significantly increased in group S at T2 as compared with the baseline before anesthesia at T0（P 0.05）.The concentrations of ACTH and E in plasma at T3 were different between group P and group S（P 0.05）.No statistic difference was observed in the recovery time of spontaneous respiration,eyes-open,the awake time of consciousness,extubation time and Steward score of both groups（P 0.05）.Conclusion The anesthesia with sufentanil-propofol for the elderly patients during LC could better suppress the stress response than sufentanil-sevoflurane without obviously influence on anesthetic recovery.