丙泊酚全凭静脉麻醉在老年食管癌患者术中的应用

Application of Propofol Total Intravenous Anesthesia in Elderly Patients with Esophageal Carcinoma Surgery

目的探讨丙泊酚全凭静脉麻醉在老年食管癌(EC)患者术中的应用效果。方法选取2018年12月至2020年12月在西峡县人民医院行手术治疗的100例老年EC患者作为研究对象,根据术中麻醉方案分为吸入组(七氟烷吸入麻醉)与静脉组(丙泊酚全凭静脉麻醉),各50例。记录患者入室时(T_(0))、插管时(T_(1))、切皮时(T_(2))、手术结束即刻(T_(3))的平均动脉压(MAP)与心率(HR);麻醉后恢复情况(术后睁眼时间和术后拔管时间)及围手术期认知功能[蒙特利尔认知评估量表(MoCA)评分]。结果与T_(0)时比较,两组T_(1)、T_(2)、T_(3)时MAP值均升高,T_(1)时HR值均降低,T_(2)、T_(3)时HR值均升高,差异有统计学意义(P<0.05);与T_(1)时比较,两组T_(2)、T_(3)时MAP、HR值均升高,差异有统计学意义(P<0.05);与T_(2)时比较,两组T_(3)时MAP值、HR值均降低,差异有统计学意义(P<0.05);但组间同个时点MAP、HR值比较,差异无统计学意义(P>0.05)。静脉组术后睁眼时间、拔管时间均短于吸入组,差异有统计学意义(P<0.05)。术后1 d,两组MoCA评分均降低,且吸入组MoCA评分低于静脉组,差异有统计学意义(P<0.05)。结论在老年EC患者术中运用七氟烷吸入麻醉与丙泊酚全凭静脉麻醉对患者的血流动力学影响类似,但丙泊酚全凭静脉麻醉更利于患者麻醉后苏醒,且对术后认知功能影响较小。

Objective To investigate the application effect of propofol total intravenous anesthesia in elderly patients with esophageal carcinoma(EC)surgery.Methods The clinical data of 100 elderly EC patients who underwent surgical treatment in Xixia County People’s Hospital from December 2018 to December 2020 were retrospectively analyzed.According to the anesthesia plan during surgery,the patients were divided into an inhalation group(sevoflurane inhalation anesthesia,50 cases)and a vein group(propofol total intravenous anesthesia,50 cases).The mean arterial pressure(MAP)and heart rate(HR)at the time of entering the room(T_(0)),intubation(T_(1)),skin incision(T_(2)),immediately at the end of surgery(T_(3)),recovery after anesthesia(eye opening time and postoperative extubation time)and perioperative cognitive function[Montreal cognitive assessment scale(MoCA)score]of patients were recorded.Results Compared with those at T_(0),MAP values at T_(1),T_(2) and T_(3) were increased,HR values were decreased at T_(1) and HR values were increased at T_(2) and T_(3) of patients in both groups(P<0.05).Compared with those at T_(1),MAP and HR values at T_(2) and T_(3) were increased of patients in both groups(P<0.05).Compared with those at T_(2),MAP value and HR value were decreased at T_(3) of patients in both groups(P<0.05).There were no differences in MAP and HR values at the same time point between the groups(P>0.05).The time of opening eyes and pulling out of the vein group were shorter than that of the inhalation group(P<0.05).One day after surgery,the MoCA scores of both groups were lower than those before surgery,and the MoCA score of inhalation group was lower than that of vein group(P<0.05).Conclusion The effect of sevoflurane inhalation anesthesia is similar to that of propofol total intravenous anesthesia on hemodynamics in elderly patients with esophageal carcinoma,but propofol total intravenous anesthesia is more beneficial to the recovery of patients after anesthesia and has less influence on cognitive function after surgery.