依托咪酯对老年腹部手术患者血流动力学及术后早期认知功能障碍的影响

Study on the effect of etomidate on hemodynamics and early postoperative cognitive dysfunction in elderly patients under abdominal operation

目的研究以依托咪酯为主的全凭静脉麻醉对老年腹部手术患者血流动力学及术后早期认知功能障碍的影响。方法行腹部手术老年患者100例(年龄>60岁,ASA分级Ⅰ~Ⅲ级),随机分为依托咪酯组(E组,n=50)和丙泊酚对照组(P组,n=50)。E组实施以依托咪酯为主的全凭静脉麻醉,P组实施以丙泊酚为主的全凭静脉麻醉。对比观察两组围术期指标;术前(T1)、诱导后(T2)、术后(T3)观察血流动力学指标;术前1 d及术后3 d、7 d使用简易智能精神状态检查量表(MMSE)评估术后认知功能障碍(POCD)的发生。结果除E组患者苏醒时间与P组相比明显延长(P<0.05)外,其余围术期观察指标两组间比较,均无显著差异(P>0.05)。两组T1、T2、T3各时间点血流动力学指标比较,差异无显著性(P>0.05)。术后3 d、7 d POCD发生率P组为16.0%和10.0%,E组为14.0%和12.0%,组间比较差异均无统计学意义(P>0.05)。结论以依托咪酯为主的全凭静脉麻醉对老年患者腹部手术血流动力学及早期POCD的发生率与丙泊酚组无显著差异。

Objective To explore the incidence of postoperative cognitive dysfunction（ POCD） and hemodynamics mainly under anesthesia with etomidate for abdominal operation in elderly patients. Methods One hundred patients（ ASAⅠ-Ⅲ） aged over 60 years old under abdominal operation were randomly divided into etomidate group（ E group,n=50） and propofol control group（ P group,n=50）. Patients in E group were induced with continuous intravenous infusion of etomidate and patients in P group were induced with continuous intravenous infusion of propofol. The perioperative hemodynamic indexes were observed and compared before operation（ T1）,after induction（ T2） and after operation（ T3）. The mini-mental status examination（ MMSE） was applied to evaluate POCD before surgery,and 3 d and 7 d after surgery. Results The recovery time of E group was significantly longer than that of P group（ P〈0.05）,there was no significant difference in other perioperative indexes between these two groups（ P〉0.05）. There was no significant difference in hemodynamic indexes at T1,T2 and T3 between these two groups（ P〉0.05）. The incidence rates of POCD at day 3 and day 7 were 16% and 10% in P group and 14% and 12% in E group respectively,there was no difference in the incidence of POCD between these two groups（ P=0. 05）. Conclusion There was no significant difference in hemodynamic indexes and the incidence of early POCD in elderly patients under abdominal operation with etomidate based total intravenous anesthesia or propofol based intravenous anesthesia.