复合麻醉药对腹腔镜卵巢囊肿切除术后意识状态和认知功能影响的观察

Effects of compound anesthetics on consciousness and cognitive function after laparoscopic ovarian cystectomy and coping strategies

目的比较不同复合麻醉方式对腹腔镜卵巢囊肿切除术后意识状态和认知功能的影响。方法选取2018年6月至2019年1月上海交通大学医学院附属新华医院收治的70例卵巢囊肿患者,均于腹腔镜下实施卵巢囊肿切除术。采用随机数字表法将其分为观察组和对照组,每组35例。对照组采用"丙泊酚+苯磺顺阿曲库铵+芬太尼"诱导麻醉,术中"吸入七氟烷+静脉芬太尼和苯磺顺阿曲库铵"维持麻醉;观察组采用"丙泊酚+苯磺顺阿曲库铵+咪达唑仑+瑞芬太尼"诱导麻醉,术中"静脉丙泊酚+瑞芬太尼"维持麻醉。比较两组麻醉诱导时间、苏醒时间和定向力恢复时间,记录不同时期患者生命体征、评价患者意识状态和认知功能,并记录麻醉相关不良反应情况。结果观察组麻醉诱导时间、清醒时间和定向力恢复时间均短于对照组(P<0.05),各时间点的警觉-镇静量表(observer assessment of sedation, OAAS)评分和认知功能量表(mini-mental state examination, MMSE)评分高于对照组(P<0.05)。手术不同时期两组HR、MAP和SpO2差异均无统计学意义,且麻醉相关不良反应发生率比较,差异无统计学意义(P>0.05)。结论丙泊酚复合瑞芬太尼麻醉起效较快,对患者生理指标影响小,利于术后意识状态和认知功能的恢复,值得临床推广。

Objective To compare the effects of different combined anesthetic methods on consciousness and cognitive function after laparoscopic ovarian cystectomy. Methods The subjects were selected from patients with ovarian cysts admitted to Xinhua Hospital Affiliated to Medical College of Shanghai Jiaotong University from June 2018 to January 2019. All patients underwent laparoscopic ovarian cystectomy. Randomized digital table method was used to divide patients into observation group and control group(35 cases each). The control group was anesthetized with propofol, fentanyl and cisatracurium besilate. And the anesthesia was maintained by inhalation of seven fluoroalkane and intravenous fentanyl and cisatracurium besilate. The observation group was induced with midazolam, remifentanil, cisatracurium besilate and propofol. And the anesthesia was maintained by continuous infusion of propofol and remifentanil of micropump. The anesthesia induction time, recovery time and orientation recovery time were compared between the two groups. The vital signs of patients in different periods were recorded, the patient’s state of consciousness and cognitive function were evaluated, and anesthesia-related adverse reactions were recorded. Results The anesthesia induction time, awake time and orientation recovery time of the observation group were shorter than those of the control group(P < 0.05). The observer assessment of sedation(OAAS) score and minimental state examination(MMSE) score at each time point were higher than those of the control group(P < 0.05). There were no significant differences in HR, MAP and SpO2 between the two groups at different time points, and there was no significant difference in the incidence of anesthesia-related adverse reactions between the two groups(P > 0.05). Conclusions Propofol combined with remifentanil has a faster effect and less effect on the physiological indexes, which is beneficial to the recovery of postoperative consciousness and cognitive function, and is worthy of clinical promotion.