七氟烷对老年胆囊结石患者行腹腔镜手术的麻醉效果分析

Analysis of anesthetic effect of sevoflurane on elderly patients with cholecystolithiasis treated with laparoscopic surgery

目的探讨七氟烷麻醉对行腹腔镜手术的老年胆结石患者血流动力学、血浆皮质醇(Cor)、心钠素(ANP)及血清肾上腺素(E)、去甲肾上腺素(NE)水平的影响。方法选择丹阳市中医院2020年1月至12月收治的60例行腹腔镜手术的老年胆囊结石患者作为研究对象,采用随机数字表法分为对照组和研究组,各30例。两组患者均行腹腔镜手术,对照组患者术中采用丙泊酚与瑞芬太尼复合维持麻醉,研究组患者术中采用七氟烷与瑞芬太尼复合维持麻醉。对比两组患者麻醉相关指标,麻醉前、麻醉后20 min、手术开始10 min、术后即刻的平均动脉压(MAP)、心率(HR)水平变化,术前与术后48 h血浆Cor、ANP,血清E、NE水平及简易精神状态量表(MMSE)评分,苏醒后、苏醒后30 min警觉-镇静评分(OAAS),术后48 h内不良反应发生情况。结果研究组患者恢复自主呼吸、指令动作恢复、言语顺利应答、拔管时间均显著短于对照组;与麻醉前比,麻醉后20 min至术后即刻对照组患者MAP水平先降低后升高,研究组患者各时间点MAP水平均显著高于对照组,两组患者HR水平先升高后降低,且研究组患者各时间点HR水平均显著低于对照组(均P<0.05);且麻醉后20 min至术后即刻研究组患者MAP变化不显著,差异无统计学意义(P>0.05);与术前比,术后48 h两组患者血浆Cor、ANP水平,血清E及对照组患者血清NE水平均显著升高,但研究组各指标显著低于对照组;研究组患者苏醒后即刻、苏醒后30 min OAAS均显著高于对照组;与术前比,术后48 h两组患者MMSE评分均显著降低,但研究组显著高于对照组;研究组患者术后48 h不良反应总发生率为6.67%,显著低于对照组的23.33%(均P<0.05)。结论在老年胆囊结石患者行腹腔镜手术术中应用七氟烷麻醉取得的麻醉效果更为理想,对患者血流动力学、认知功能、智力状态影响小,且应激反应轻微,术后不良反应较少,安全性更高。

Objective To investigate the effects of sevoflurane anesthesia on the hemodynamics, plasma cortisol(Cor), atrial natriuretic peptide(ANP) and serum,epinephrine(E), norepinephrine(NE) levels in elderly patients with cholecystolithiasis treated with laparoscopic surgery. Methods A total of 60 elderly patients with cholecystolithiasis treated with laparoscopic surgery admitted to the Danyang Hospital of Traditional Chinese Medicine from January 2020 to December 2020 were selected and acted as the research subjects, and they were divided into the control group and the research group according to the random number table method, with 30 cases in each group. Patients in the both groups were treated with laparoscopic surgery, and patients in the control group received propofol and remifentanil for anesthesia maintenance,and patients in the research group received sevoflurane and remifentanil for anesthesia maintenance. the anesthesia-related indicators of patients were compared between the two groups;and the changes of the mean arterial pressure(MAP), heart rate(HR) levels before anesthesia,20 min after anesthesia, 10 min after the surgery started, and immediately after surgery of patients in the two groups were compared;the levels of plasma Cor, ANP and serum E, NE, and mini-mental state scale(MMSE) scores before and 48 h after surgery, the observer assessment of sedation(OAAS) score after awakening and 30 min after awakening, the occurrence of adverse reactions within 48 h after surgery of patients in the two groups were compared. Results The recovery of spontaneous breathing time, the recovery of command movements time, the smooth response to speech time, and the extubation time of the patients in the research group were significantly shorter than those in the control group;compared with before anesthesia, the MAP level of patients in the control group decreased at first and then increased from 20 min after anesthesia to immediately after surgery, and the MAP levels of patients in the research group at each time point was significantly higher than those in the control group;the HR levels of patients in the two groups increased first and then decreased, and the HR levels of patients in the research group at each time point was significantly lower than those in the control group(P<0.05);and the MAP level of patients in the research group from 20 min after anesthesia to immediately after surgery didn’t significantly changed, and the difference was not statistically significant(P>0.05), compared with before surgery, the levels of plasma Cor, ANP and serum E of patients in th two groups, and the NE level of patients in the control group 48 h after the surgery significantly increased, but the above indexes in the research group were significantly lower than those in the control group;the OAAS scores of the patients in the research group awakening and 30 min after awakening were significantly higher than those in the control group;compared with before surgery, the MMSE scores of patients in the two groups at 48 h after surgery significantly decreased, but the research group was significantly higher than the control group;the total incidence of adverse reactions of patients 48 h after surgery in the research group was 6.67%, which was significantly lower than that in the control group(23.33%)(all P<0.05). Conclusion The application of sevoflurane anesthesia in the laparoscopic surgery for elderly patients with cholecystolithiasis can achieve better anesthesia effect, with little impact on the patient’s hemodynamics, cognitive function and mental state, the stress reaction is mild, the postoperative adverse reactions is less relatively, and with more security.