丙泊酚与瑞芬太尼静吸复合麻醉对老年腹腔镜下胆囊切除术患者术后认知功能的影响

Effect of propofol and remifentanil intravenous inhalational anesthesia on postoperative cognitive function of elderly patients undergoing laparoscopic cholecystectomy

目的观察丙泊酚与瑞芬太尼静吸复合麻醉对老年腹腔镜下胆囊切除术(LC)患者术后认知功能的影响。方法选取2013年1月~2018年9月于我院行LC老年患者80例,随机分为两组,各40例。一组行丙泊酚与瑞芬太尼靶控输注(TCI)麻醉,设为TCI组;另一组行丙泊酚与瑞芬太尼静吸复合麻醉,设为复合组。记录两组手术时间及术后恢复情况,观察两组认知功能及意识状态变化。结果两组手术时间及术后拔管时间无统计学差异(P> 0.05);复合组术后自主呼吸恢复时间、苏醒时间及定向力恢复时间短于TCI组(P <0.05)。术前1d、术后1d两组简易精神评价量表(MMSE)评分无统计学差异(P> 0.05);术后1h、术后3h复合组MMSE评分高于TCI组(P <0.05)。术后即刻、术后1h、术后3h复合组警觉/镇静评分(OAA/S)评分高于TCI组(P <0.05);术后1d两组OAA/S评分无统计学差异(P> 0.05)。结论丙泊酚与瑞芬太尼静吸复合麻醉较TCI麻醉患者术后恢复快、苏醒质量高,对患者术后认知功能及意识状态影响较小。

Objective To observe the effect of propofol and remifentanil intravenous inhalation anesthesia on postoperative cognitive function of elderly patients undergoing laparoscopic cholecystectomy(LC). Methods 80 elderly patients undergoing LC in our hospital from January 2013 to September 2018 were selected and they were randomly divided into two groups, with 40 cases in each group. The TCI group was given propofol and remifentanil target-controlled infusion(TCI) anesthesia while the composite group was given propofol and remifentanil intravenous inhalation anesthesia. The operation time and postoperative recovery of the two groups were recorded and the changes of cognitive function and consciousness state were observed. Results There was no significant difference in operation time and postoperative extubation time between the two groups(P > 0.05). The postoperative recovery time of spontaneous respiration, awakening time and recovery time of orientation in the composite group were shorter than those of the TCI group(P < 0.05). There was no significant difference in the scores of mini-mental state examination(MMSE) of 1 day before and after the surgery in the two groups(P > 0.05). The MMSE score of1 hour and 3 hour after operation of the composite group were higher than that of the TCI group(P < 0.05). The observer’s assessment of alertness/sedation(OAA/S) score of the composite group was higher than those of the TCI group immediately after surgery, 1 hour and 3 hours after operation(P < 0.05). There was no significant difference in OAA/S score between the two groups on 1 day after operation(P > 0.05). Conclusion The propofol and remifentanil intravenous inhalation anesthesia has faster postoperative recovery than the TCI anesthesia and the quality of recovery is higher. It has less effect on postoperative cognitive function and consciousness state.