依托咪酯乳剂复合舒芬太尼对老年妇科腹腔镜术后患者早期认知功能的影响

Effects of Etomidate combined with Sufentanil in gynecological laparoscopic operation in elderly patients with cerebral oxygen metabolism and cognitive function

目的 探讨依托咪酯复合舒芬太尼对老年妇科腹腔镜手术后患者早期认知功能的影响.方法 选择全麻下行择期妇科腹腔镜手术且年龄60-79岁的患者80例,随机分为依托咪酯复合舒芬太尼组（ES组）和对照组（C组）.其中ES组患者行依托咪酯＋舒芬太尼全麻诱导并持续静脉微泵依托咪酯麻醉维持,C组患者行丙泊酚＋芬太尼全麻诱导并持续静脉微泵丙泊酚麻醉维持.观察并记录围术期的血压和心率,分别在术前及术后第1、7、12、24、48、72小时进行神经心理学评估,采用简易智能量表（MMSE）测试.结果 两组患者年龄、体重、受教育程度、手术时间和术中出血量等比较差异均无统计学意义（P＞0.05）.两组全麻诱导后平均动脉压和心率均较基础值显著降低（P＜ 0.05）,且ES组心率明显高于C组（t=3.846,P=0.000）,而插管后即刻ES组心率明显低于C组（t=3.547,P=0.001）,ES组平均动脉压明显也低于C组（t=3.463,P=0.001）.术后第1、7小时的MMSE评分均较术前显著下降（P＜0.05）,且术后12 h ES组MMSE评分明显高于C组（t=3.257,P=0.001）,其中ES组有8例出现术后认识功能障碍（POCD）,发生率为20.0％,C组共有11例出现POCD,发生率为27.5％,两组比较差异无统计学意义（P＞0.05）.结论 依托咪酯乳剂复合舒芬太尼可安全地应用于老年妇科腹腔镜手术患者全身麻醉,不会增加术后认知功能障碍的发生.

Objective To observe the effects of Etomidate combined with Sufentanil on cognitive dysfunction early after gynecological laparoscopic surgery in elderly patients. Methods Eighty ASA Ⅰ - Ⅱ patients of female sex, aged 60-79 year, cheduled for selective gynecological laparoscopic surgery were randomly divided into 2 groups： Etomidate com- bined with Sufentanil group （group ES） and control group （group C）, the patients in group ES received induction of gen- eral anesthesia by Etomidate with Sufentanil and micro pump continuous intravenous anesthesia maintenance by Etomi- date, the patients in group C received induction of general anesthesia by Propofol with Fentanyl and micro pump con- tinuous intravenous anesthesia maintenance by Propofol. BP, HR, RR and SpO 2＇ were measured and recorded in periop- eration. All patients were tested with neuropsychological tests of mini-mental state examination at preoperatively, 1, 7, 12, 24 h and 48 h postoperatively. Results No significant difference was found in old, weight, education level, operation time and bleeding volume between 2 groups （P 〉 0.05）. Compared with the baseline values, the MAP and HR de- creased significantly after general anesthesia in both groups （P 〈 0.05）. And the heart rate of group ES was significantly higher than that of group C （t = 3.846, P = 0.000）, but the heart rate of group ES was significantly lower than that of group C after intubation （t = 3.547, P = 0.001）, and the MAP of group ES was also lower than that of group C （t = 3.463,P = 0.001）. Compared with the baseline values, the MMSE scores decreased significantly at l, 7 h aftersurgery in both groups. But the MMSE scores of group ES at 12 h after surgery was significantly higher than that of group C （t = 3.257, P = 0.001）, the difference was statistically significant （P 〈 0.05）. The incidence of postoperative cognitive dysfunction in group ES and control group was 20.0% （8 cases） and 27.5% （11 cases）, respectively, however there was no significant difference between the 2 groups （P 〉 0.05）. Conclusion Etomidate combined with Sufentanil can be safely used in the elderly patients with general anesthesia in gynecological laparoscopic surgery, and it will not influence the incidence of cognitive dysfunction early after gynecological laparoscopic surgery in elderly patients.