丙泊酚复合瑞芬太尼对高血压腹部手术患者血流动力学、炎症因子及认知功能的影响

Effects of Propofol Combined with Remifentanil on Hemodynamics,Inflammatory Factors and Cognitive Function in Patients Undergoing Abdominal Surgery for Hypertension

目的:探讨丙泊酚复合瑞芬太尼对高血压腹部手术患者血流动力学、炎症因子及认知功能的影响。方法:选取2018年2月~2020年2月期间我院收治的高血压行腹部手术患者150例,上述患者根据随机数字表法分为对照组(n=75)和研究组(n=75),对照组患者予以丙泊酚维持麻醉,研究组予以丙泊酚复合瑞芬太尼维持麻醉,比较两组患者围术期指标、血流动力学、炎症因子及认知功能情况。结果:研究组呼吸恢复时间、拔气管导管时间、苏醒时间均短于对照组(P<0.05)。研究组手术结束(T1)~拔管后(T3)时间点心率(HR)、收缩压(SBP)、舒张压(DBP)均高于对照组(P<0.05)。研究组术后3d、术后5d白介素-1(IL-1)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)低于对照组(P<0.05)。研究组术后1d、术后3d、术后5d简易智力状态检查表(MMSE)评分均高于对照组(P<0.05)。研究组术后1d、术后3d的POCD发生率低于对照组(P<0.05)。结论:高血压腹部手术患者麻醉维持选用瑞芬太尼复合丙泊酚方案,可维持机体血流平稳,减轻机体炎症应激及认知功能损害,具有较高的临床应用价值。

Objective: To investigate the effect of propofol combined with remifentanil on hemodynamics, inflammatory factors and cognitive function in patients with hypertension undergoing abdominal surgery. Methods: From February 2018 to February 2020, 150 patients who hypertension underwent abdominal surgery in our hospital were selected. The patients were divided into control group(n=75) and study group(n=75) according to the random number table method. The patients in the control group were given propofol maintenance anesthesia, while the patients in the study group were given propofol combined with remifentanil maintenance anesthesia.The perioperative indexes, hemodynamics, inflammatory factors and cognitive function of the two groups were compared. Results: The respiratory recovery time, tracheal catheter extraction time and resuscitation time of the study group were shorter than those of the control group(P<0.05). The heart rate(HR), systolic blood pressure(SBP) and diastolic blood pressure(DBP) at the time point between end of the operation(T1) and after extubation(T3) were all higher in the study group than in the control group(P<0.05). Interleukin-1(IL-1),interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α) of the study group at 1 d after operation, 3 d after operation, 5 d after operation were lower than those of the control group(P<0.05). The scores of mini-mental state examination(MMSE) of the study group were higher than those of the control group(P<0.05). The incidence of POCD of the study group at 1 d after operation, 3 d after operation were lower than those of the control group(P<0.05). Conclusion: Remifentanil for maintenance of anesthesia in patients with hypertensive abdominal surgery conforms to the propofol scheme, which can maintain the stable blood flow, reduce the body’s inflammatory stress and cognitive impairment, and has high clinical application value.