腹腔镜下宫颈癌根治术中脑电双频指数指导下七氟醚吸入复合麻醉对患者认知功能和血清Cor、Ang-Ⅱ的影响

Effects of sevoflurane inhalation combined anesthesia guided by bispectral index during laparoscopic radical resection of cervical cancer of patients on their cognitive function and the levels of serum cortisol and angiotensinⅡ

目的:探讨脑电双频指数(BIS)指导下七氟醚吸入复合麻醉对腹腔镜下宫颈癌根治术患者认知功能和血清皮质醇(Cor)、血管紧张素Ⅱ(Ang-Ⅱ)的影响.方法:选取2018年1月—2021年3月于本院接受宫颈癌根治术治疗的宫颈癌患者106例,随机分为观察组与对照组各53例,两组均给予七氟醚吸入复合丙泊酚麻醉,对照组由麻醉医师按照临床经验用药、观察组在BIS指导下操作,比较两组麻醉药物用量、血压心率指标[收缩压(SBP)、舒张压(DPB)和心率(HR)]、血清指标[血清皮质醇(Cor)、血管紧张素Ⅱ(Ang-Ⅱ)]、苏醒质量、认知功能MMSE评分.结果:两组七氟醚、芬太尼用量无差异(P>0.05),丙泊酚用量观察组少于对照组(P<0.05);观察组气腹后10min、气腹后30min、术毕时HR水平低于对照组,SBP、DPB水平高于对照组,术毕时、术后2h血清Cor、Ang-Ⅱ水平均低于对照组,术后意识恢复时间、自主呼吸恢复时间、清醒时间均短于对照组(均P<0.05);术前、术后7d认知功能两组无差异(P>0.05),术后1d、3d、5d认知功能MMSE评分观察组高于对照组(P<0.05).结论:腹腔镜下宫颈癌根治术中BIS值指导七氟醚吸入复合麻醉用药可减少相关麻醉药物使用量,降低患者应激反应,且患者术后认知功能恢复更快,对于避免患者苏醒延迟也有积极意义.

Objective: To explore the effects of sevoflurane inhalation combined anesthesia guided by bispectral index(BIS) during laparoscopic radical resection of cervical cancer of patients on their cognitive function and their serum cortisol(Cor) and angiotensin II(Ang-II) levels. Methods: A total of 106 patients who wanted laparoscopic radical resection of cervical cancer were enrolled and were randomly divided into two groups(53 cases in each group) between January 2018 and March 2021. The patients in the two groups were all given sevoflurane inhalation combined with propofol for anesthetics. The patients in the control group were given the anesthetics according to clinical experience of anesthesiologists, while the patients in the observation group were given the anesthetics guided by BIS. The dosages of anesthetics, the values of blood pressure indexes, such as systolic blood pressure(SBP), diastolic blood pressure(DPB), the heart rate(HR), the values of serum indexes, such as Cor and Ang-II, the recovery quality score, and the score of cognitive function MMSE of the patients were compared between the two groups. Results: There was no significant difference in the dosage of sevoflurane of the patients between the two groups(P>0.05), and the dosage of propofol of the patients in the observation group was significantly lower than that of the patients in the control group(P<0.05). The HR value of the patients in the observation group at 10 min or 30 min after pneumoperitoneum, or at the end of the operation was significantly lower than that of the patients in the control group, but the values of SBP and DPB of the patients in the observation group were significantly higher than those of the patients in the control group. The levels of Cor and Ang-Ⅱof the patients in the observation group at the end of the operation or at postoperative 2 h were significantly lower than those of the patients in the control group,and the postoperative consciousness recovery time,the spontaneous breathing recovery time,and the awake time of the patients in the observation group were significantly shorter than those of the patients in the control group(all P<0.05).There was no significant difference in the cognitive function of the patients at 7days before and after operation between the two groups(P>0.05).MMSE score of cognitive function of the patients in the observation group in the 1st d,the 3rd d,or the 5th d after operation was significantly higher than that of the patients in the control group(P<0.05).Conclusion:Sevoflurane inhalation combined anesthesia guided by BIS during laparoscopic radical resection of cervical cancer of the patients can reduce their dosages of related anesthetics used,can decrease their stress response,and can fast the recovery of their postoperative cognitive function,which is also of positive significance in avoiding awakening delay.