全凭静脉麻醉与静脉-吸入复合麻醉对老年患者腹腔镜辅助胃癌根治术后苏醒质量的影响

Effect of total intravenous anesthesia and intravenous inhalational anesthesia on quality of resuscitation in laparoscopic assisted radical gastrectomy in gerontal patients

目的比较全凭静脉麻醉与静脉-吸入复合麻醉对老年患者腹腔镜辅助胃癌根治术后苏醒质量的影响。方法将2016年1月至2016年12月解放军医学院收治的86例拟行全身麻醉下腹腔镜辅助胃癌根治术的老年患者分为全凭静脉麻醉组和静脉-吸入复合麻醉组,每组43例,术中分别给予全凭静脉麻醉和静脉-吸入复合麻醉。比较2组患者麻醉结束后自主呼吸恢复时间、气管插管拔除时间、定向力恢复时间;麻醉前及麻醉结束后6、12、24 h采用简易精神状况检查表(MMSE)评估2组患者短期认知能力,并观察麻醉结束后6、12、24 h患者术后认知功能障碍(POCD)发生率;记录2组患者苏醒期不良反应发生率。结果全凭静脉麻醉组患者麻醉结束后恢复自主呼吸时间、气管插管拔出时间及定向力恢复时间均短于静脉-吸入复合麻醉组(P<0.05)。2组患者麻醉前MMSE评分比较差异无统计学意义(P>0.05);麻醉结束后6 h,全凭静脉麻醉组患者MMSE评分高于静脉-吸入复合麻醉组(P<0.05);麻醉结束后12、24 h,2组患者MMSE评分比较差异无统计学意义(P>0.05)。麻醉结束后6、12、24 h,全凭静脉麻醉组患者POCD发生率分别为4.7%(2/43)、2.3%(1/43)和2.3%(1/43),静脉-吸入复合麻醉组患者POCD发生率分别为18.6%(8/43)、9.3%(4/43)和4.7%(2/43);麻醉结束后6 h,全凭静脉麻醉组患者POCD发生率低于静脉-吸入复合麻醉组(χ2=4.074,P<0.05);麻醉结束后12、24 h,2组患者POCD发生率比较差异无统计学意义(χ2=1.911、0.345,P>0.05)。全凭静脉麻醉组和静脉-吸入复合麻醉组患者苏醒期麻醉相关不良反应发生率分别为2.3%(1/43)、14.0%(6/43),全凭静脉麻醉组患者苏醒期麻醉相关不良反应发生率低于静脉-吸入复合麻醉组(χ2=3.888,P<0.05)。结论老年患者行腹腔镜辅助胃癌根治术中采用全凭静脉麻醉具有术后气管插管拔除早、恢复自主呼吸和定向力快等优点,且短期POCD发生率及苏醒期麻醉相关不良反应发生率低。

Objective To evaluate the effect of total intravenous anesthesia and intravenous inhalational anesthesia on quality of resuscitation in laparoscopic assisted radical gastrectomy in gerontal patients.Methods Eighty-six gerontal patients underwent the laparoscopic assisted radical gastrectomy for stomach cancer in Medical School of Chinese PLA from January 2016 to December 2016,were randomly divided into total intravenous anesthesia group and intravenous inhalational anesthesia group,with 43 patients in each group.The patients were given total intravenous anesthesia and intravenous inhalational anesthesia in the total intravenous anesthesia group and intravenous inhalational anesthesia group respectively.The recovery time of spontaneous breath,the time of tracheal extubation,the recovery time of directional force after the end of anesthesia were compared between the two groups.The short-term cognition of the patients in the two groups were evaluated by mini-mental state exam(MMSE)before anesthesia and at 6,12,24 hours after the end of anesthesia,the incidence of short-term postoperative cognitive dysfunction(POCD)were observed at 6,12,24 hours after the end of anesthesia.The incidence of adverse reactions during the recovery period in the two groups was recorded.Results The recovery time of spontaneous breath,the time of tracheal extubation,the recovery time of directional force in the total intravenous anesthesia group was shorter than those in the intravenous inhalational anesthesia group after the end of anesthesia(P<0.05).There was no significant difference in the MMSE score between the two groups before anesthesia(P>0.05).At 6 hours after the end of anesthesia,the MMSE score in the total intravenous anesthesia group was higher than that in the intravenous inhalational anesthesia group(P<0.05),while at 12,24 hours after the end of anesthesia,there was no significant difference in the MMSE score between the two groups(P>0.05).At 6,12,24 hours after the end of anesthesia,the incidence of short-term POCD was 4.7%(2/43),2.3%(1/43),2.3%(1/43)in the total intravenous anesthesia group,while it was 18.6%(8/43),9.3%(4/43),4.7%(2/43)in the intravenous inhalational anesthesia group.The incidence of short-term POCD in the total intravenous anesthesia group was lower than that in the intravenous inhalational anesthesia group at 6 hours after the end of anesthesia(χ2=4.074,P<0.05),but there was no statistically significant difference between the two groups at 12 and 24 hours after the end of anesthesia(χ2=1.911,0.345;P>0.05).The incidence of adverse reactions in the total intravenous anesthesia group and in the intravenous inhalational anesthesia group was 2.3%(1/43),14.0%(6/43)during the recovery period,respectively.The incidence of adverse reactions during the recovery period in the total intravenous anesthesia group was lower than that in the intravenous inhalational anesthesia group(χ2=3.888,P<0.05).Conclusion Total intravenous anesthesia in laparoscopic assisted radical gastrectomy for stomach cancer in gerontal patients has the advantage of short time of tracheal extubation,recovery spontaneous breath and recovery directional force,and the incidence of short-term POCD and the incidence of adverse reactions during the recovery period was low.