不同麻醉维持方式在妇科老年患者腹腔镜手术中的应用效果及对术后恢复的影响

Effect of different methods of anesthesia maintenance on clinical efficacy and postoperative recovery in elderly patients with gynecological diseases undergoing laparoscopic surgery

目的分析不同麻醉维持方式在妇科老年患者腹腔镜手术中的应用效果及对术后恢复的影响。方法本研究共纳入2015年1月到2016年12月在我院妇科行腹腔镜手术治疗的老年患者80例，随机分为两组，每组40例，分别采用静吸复合麻醉维持方式和单纯静脉麻醉维持方式，分析和比较两组患者的手术情况、麻醉前后动脉血气、血压、心率变化、麻醉前后认知功能情况，以及术后并发症。结果两组患者在苏醒时间、拔管时间和话语时间方面差异无统计学意义（均P〉0．05），两组患者麻醉前后动脉血气、血压和心率均较稳定，二组差异无统计学意义（P〉0．05）。但是，单纯静脉麻醉维持方式对患者术后认知功能的影响程度要小于静吸复合麻醉维持方式，尤其拔管后6h，单纯静脉麻醉组患者MMSE评分为（28．8±0．5）分，明显高于静吸复合麻醉组患者（25．1±0．6）分（P〈0.05）。另外，在并发症发生率方面，两组患者差异无统计学意义（P〈0．05）。结论静吸复合麻醉和单纯静脉麻醉两种麻醉维持方式均能够保证妇科老年患者腹腔镜手术的顺利开展，但单纯静脉麻醉维持方式对老年患者腹腔镜手术后认知功能的影响较小，可作为老年患者腹腔镜手术常规的麻醉维持方式。

Objective To analyze the effect of different methods of anesthesia maintenance on clinical efficacy and postoperative l＇ecovery in elderly patients with gynecological diseases undergoing laparoseopie surgery. Methods A total of 80 elderly patients with gynecological diseases scheduled for laparoscopic surgery were enrolled in this study in our hospital from January 2015 to December 2016. All the patients were randomly divided into two groups of anesthesia maintenance： an intravenous anesthesia alone （n= 40） and a combined intravenous and inhaled anesthesia （n= 40）. The pre-and post-anesthesia changes in arterial blood gas, blood pressure, heart rate and cognitive function,and postoperative complications were analyzed and compared between the two groups. Results There were no significant differences between the two groups in the times of palinesthesia, extubation and talking （all P〉 0.05 ）. After anesthesia, the levels of arterial blood gas, the blood pressure and the heart rate were relatively stable in both groups, and their differences between the two groups were without statistically significant （all P 〉 0.05 ）. While, the postoperative cognitive function recovered more rapidly in patients receiving intravenous anesthesia alone for anesthesia maintenance than in those receiving a combined intravenous and inhaled anesthesia, especially at 6 h after extubation. The Mini-mental State Examination （MMSE） score was significantly higher in patients receiving intravenous anesthesia alone （ 28.8 ± 0.5 ） than in patients receiving a combined intravenous and inhaled anesthesia （25.1±0.6 ） , with statistically significant difference （P〈 0.05 ） , In addition, there was no statistical difference between the two groups in the incidence of complications. Conclusions As anesthesia maintenance, both an intravenous anesthesia alone and a combined intravenous and inhaled anesthesia can ensure a successfully laparoscopic surgery for gynecological diseases in elderly patients. However, the impact on cognitive function after laparoscopie surgery is smaller in the maintenance of intravenous anesthesia alone than in a combined intravenous and inhaled anesthesia in elderly patients. Intravenous anesthesia alone can be used in elderly patients to receive laparoscopie surgery as routine anesthesia maintenance.