摘要
目的研究七氟醚静脉复合麻醉对宫颈癌腹腔镜下根治术患者血流动力学、超氧化物歧化物酶(SOD)、脑源性神经营养因子(BDNF)及术后认知功能的影响。方法开展前瞻性研究,将2020年6月至2021年6月联勤保障部队第901医院收治的60例宫颈癌腹腔镜下根治术患者纳为研究对象,按照随机数字表法将其分为A组(n=30)与B组(n=30)。A组给予七氟醚静吸复合麻醉,B组给予丙泊酚全凭静脉麻醉。比较两组围术期血流动力学、疼痛程度、血清SOD、BDNF水平及术后认知功能。结果A组麻醉前(T0)、气管插管即刻(T1)、切皮时(T2)以及术毕时(T3)不同时间点,组内收缩压水平比较,差异均无统计学意义(P>0.05),B组T1及T2时收缩压水平较T0时上升,且T1、T2时收缩压水平高于A组,差异均有统计学意义(P<0.05)。两组组内不同时间点舒张压及氧饱和度水平比较,差异均无统计学意义(P>0.05)。两组T1时平均动脉压(MAP)水平均较T0时上升,T2时有所回落,A组T1时MAP水平低于B组,差异均有统计学意义(P<0.05)。两组T3时心率较T0时均有所降低,差异均有统计学意义(P<0.05)。术后12、24、48 h,两组疼痛VAS量表得分均随时间呈依次下降趋势,且A组术后12 h的VAS得分均低于B组,差异均有统计学意义(P<0.05)。术后,两组SOD水平均较其术前下降,B组术后BDNF水平较其术前下降,差异均有统计学意义(P<0.05);A组术前、术后BDNF水平比较,差异无统计学意义(P>0.05);A组术后血清SOD及BDNF水平均高于B组,差异均有统计学意义(P<0.05)。A组术前及术后简易智能状态检查量表(MMSE)得分比较,差异无统计学意义(P>0.05),B组术后MMSE量表得分较其术前下降,A组术后MMSE量表得分高于B组,差异均有统计学意义(P<0.05)。A组术后恢复质量量表(QoR-40量表)总得分高于B组,差异有统计学意义(P<0.05)。结论与丙泊酚全凭静脉麻醉相比,七氟醚静吸复合麻醉有助于提高腹腔镜宫颈癌根治术患者术中血流动力学稳定性,减轻术中机体应激反应,预防术后认知障碍,有利于患者术后恢复。
Objective To investigate the clinical effect of combined intravenous-inhalational anesthesia with sevoflurane on hemodynamics,superoxide dismutase(SOD),brain-derived neurotrophic factor(BDNF)expression and postoperative cognitive function in patients undergoing laparoscopic radical hysterectomy for cervical cancer.Methods Conducting prospective studies,sixty patients undergoing laparoscopic radical hysterectomy for cervical cancer in No.901 Hospital of Joint Logistics Support Force from June 2020 to June 2021 were selected,and divided into group A(n=30)and group B(n=30)according to random number table method,each with 30 cases.Group A was given combined intravenous-inhalational anesthesia with sevoflurane,and group B was given total intravenous anesthesia with propofol.Then the perioperative hemodynamics,pain level,serum SOD and BDNF levels and postoperative cognitive function were compared between two groups.Results The systolic blood pressure(SBP)levels before anesthesia induction(T0),immediately after endotracheal intubation(T1),at skin incision(T2)and the end of surgery(T3)had no significant difference within group A(P>0.05).Compared with data at T0,SBP at T1 and T2 was increased in group B,and was significantly higher than that of group A at corresponding time point,the differences were statistically significant(P<0.05).There was no significant difference in diastolic blood pressure and oxygen saturation levels at different time points between the two groups(P>0.05).The mean arterial pressure(MAP)at T1 in both groups increased compared with that at T0,and began to decrease at T2,MAP of group A at T1 was lower than that of group B,the differences were statistically significant(P<0.05).The heart rate at T3 was lower than that at T0 in both groups,and the difference was statistically significant(P<0.05).At 12 h,24 h,48 h after operation,visual analogue scale(VAS)score showed a decreasing trend over time,VAS score at post-operative 12 h was in group A significantly lower than that in group B,the differences were statistically significant(P<0.05).After operation,SOD levels decreased in both groups,while BNDF levels decreased in group B,the differences were statistically significant(P<0.05)and had no significant change in group A(P>0.05).The post-operative SOD and BDNF levels were significantly higher in group A than in group B,the differences were statistically significant(P<0.05).There was no significant difference in the scores of the Mini-Mental State Examination(MMSE)before and after operation in group A(P>0.05),and the postoperative MMSE score in group B was lower than that before surgery,and the postoperative MMSE score in group A was higher than that in group B,the differences were statistically significant(P<0.05).Quality of Recovery-40 questionnaire(QoR-40)scores of group A were significantly higher than those of group B,the differences were statistically significant(P<0.05).Conclusion Compared with total intravenous anesthesia with propofol,application of combined intravenous-inhalational anesthesia with sevoflurane in patients undergoing laparoscopic radical hysterectomy for cervical cancer has the advantages of better hemodynamic stability,mild intraoperative stress reaction,lower risk of postoperative cognitive impairment and better postoperative recovery.
作者
李金贵
戚洪亮
徐娅静
LI Jin-gui;QI Hong-liang;XU Ya-jing(Department of Anesthesiology,No.901 Hospital of Joint Logistics Support Force,Hefei Anhui 230031,China)
出处
《临床和实验医学杂志》
2022年第10期1114-1118,共5页
Journal of Clinical and Experimental Medicine
基金
安徽省科技攻关计划项目(编号:1604a0802095)。
关键词
宫颈癌根治术
七氟醚静吸复合麻醉
腹腔镜
血流动力学
血清超氧化歧化酶
脑源性神经营养因子
认知功能
Radical hysterectomy
Combined intravenous-inhalational anesthesia with sevoflurane
Laparoscope
Hemodynamics
Serum superoxide dismutase
Brain derived neurotrophic factor
Cognitive function