七氟烷或异丙酚复合瑞芬太尼在老年腹腔镜胆囊切除术中麻醉效果对比评价

Comparative evaluation of anesthetic effect of sevoflurane or propofol combined with remifentanil in elderly patients undergoing laparoscopic cholecystectomy

目的研究在老年腹腔镜胆囊切除术中给予七氟烷或异丙酚复合瑞芬太尼麻醉的效果.方法78例行腹腔镜胆囊切除术治疗的老年患者,根据术中麻醉方式不同分为观察组和对照组,各39例.对照组在常规麻醉基础上使用瑞芬太尼复合异丙酚麻醉,观察组在常规麻醉基础上使用七氟烷复合瑞芬太尼麻醉.比较两组患者不同时间点苏醒期躁动情况、手术前后简易智力状态检查量表(MMSE)评分、镇静用药满意度.结果观察组患者苏醒时及苏醒后各时间点的Ricker镇静-躁动评分量表(SAS)评分分别为(3.11±0.22)、(3.22±0.33)、(3.22±0.11)、(3.11±0.11)分,均优于对照组的(4.58±0.55)、(4.55±0.55)、(4.45±0.55)、(3.55±0.55)分,差异均具有统计学意义(P<0.05);观察组患者苏醒时及苏醒后各时间点的镇静评分(Ramsay评分)分别为(3.11±0.22)、(2.66±0.33)、(2.88±0.55)、(2.66±0.55)分,均优于对照组的(1.88±0.33)、(1.25±0.22)、(1.44±0.22)、(2.11±0.11)分,差异均具有统计学意义(P<0.05).术后4、8、12h,两组患者的MMSE评分均低于术前,差异均具有统计学意义(P<0.05);观察组患者术后4、8、12h的MMSE评分分别为(18.11±2.00)、(21.00±2.11)、(27.11±3.11)分,均低于对照组的(22.33±2.55)、(26.44±2.55)、(28.66±2.55)分,差异均具有统计学意义(P<0.05).观察组患者镇静用药的总满意度97.4%(38/39)高于对照组的82.1%(32/39),差异有统计学意义(P<0.05).结论在老年患者腹腔镜胆囊切除术中给予七氟烷复合瑞芬太尼麻醉效果显著,临床应用价值较高,值得推广.

Objective To study the anesthetic effect of sevoflurane or propofol combined with remifentanil in elderly patients undergoing laparoscopic cholecystectomy. Methods A total of 78 elderly patients undergoing laparoscopic cholecystectomy were divided into observation group and control group according to different anesthetic measures during operation, with 39 cases in each group. The control group received remifentanil combined with propofol for anesthesia on the basis of conventional anesthesia, and the observation group received sevoflurane combined with remifentanil for anesthesia on the basis of conventional anesthesia. Comparison were made on emergence restlessness,mini-mental state examination(MMSE) score before and after operation, satisfaction with sedative medication between the two groups. Results The observation group had better sedation-agitation scale(SAS) score when awakening and periods after awakening respectively as(3.11±0.22),(3.22±0.33),(3.22±0.11) and(3.11±0.11) points than(4.58±0.55),(4.55±0.55),(4.45±0.55),(3.55±0.55) points in the control group. Their difference was statistically significant(P<0.05). The observation group had higher Ramsay score respectively as(3.11±0.22),(2.66±0.33),(2.88±0.55) and(2.66±0.55) points when awakening and periods after awakening than(1.88±0.33),(1.25±0.22),(1.44±0.22) and(2.11±0.11) points in the control group. Their difference was statistically significant(P<0.05). At 4, 8 and 12 h after operation, both groups had lower MMSE scores than those before operation, and their difference was statistically significant(P<0.05). At 4, 8 and 12 h after operation, the observation group had lower MMSE scores respectively as(18.11±2.00),(21.00±2.11) and(27.11±3.11) points than(22.33±2.55),(26.44±2.55) and(28.66±2.55) points. Their difference was statistically significant(P<0.05). The observation group had higher total satisfaction with sedative medication as 97.4%(38/39) than 82.1%(32/39) in the control group, and the difference was statistically significant(P<0.05). Conclusion Sevoflurane combined with remifentanil shows significant anesthetic effect in elderly patients with laparoscopic cholecystectomy, and its clinical application value is high. It is worthy of promotion.