七氟醚复合丙泊酚、瑞芬太尼麻醉对腹腔镜手术老年冠心病患者血流动力学指标、术后谵妄的影响

Influences of sevoflurane combined with propofol and remifentanil anesthesia on hemodynamic indexes and postoperative delirium in elderly patients with coronary heart disease undergoing laparoscopic surgery

目的:分析七氟醚复合丙泊酚、瑞芬太尼麻醉对腹腔镜手术老年冠心病(coronary heart disease,CHD)患者血流动力学指标、术后谵妄的影响。方法:选取2020年1月至2020年12月于山西省晋城市人民医院行腹腔镜胃肠手术的120例老年CHD患者作为研究对象,将其随机分为研究组(60例)与对照组(60例)。研究组采用七氟醚吸入复合丙泊酚、瑞芬太尼静脉滴注进行麻醉维持,对照组采用丙泊酚、瑞芬太尼静脉滴注进行麻醉维持。对2组患者在麻醉诱导前(T_(0))、气管插管时(T_(1))、气腹建立后10 min(T_(2))、拔管时(T_(3))等时点的平均动脉压(mean arterial pressure,MAP)、心率(heartrate,HR)、心输出量(cardiacoutput,CO)、心脏指数(cardiacindex,CI)、外周血管阻力(systemic vascular resistance,SVR)、左心室做功(left ventricular work,LCW)、血氧饱和度(oxygen saturation,SpO_(2))进行监测。对2组患者围手术期心血管事件发生率、血管活性药物应用情况及苏醒指标、术后谵妄发生率进行比较。结果:在T_(1)、T_(2)、T_(3)时点,研究组患者的MAP、CO、CI、SVR、LC W水平高于对照组(P<0.05),HR水平低于对照组(P<0.05)。研究组患者围手术期心肌缺血发生率及应用硝酸甘油、应用艾司洛尔的比例均低于对照组(P<0.05)。研究组患者的自主呼吸恢复时间、拔管时间、睁眼时间、言语应答时间、定向力恢复时间短于对照组(P<0.05),术后谵妄发生率低于对照组(P<0.05)。结论:在老年CHD患者腹腔镜胃肠手术中,采用七氟醚复合丙泊酚、瑞芬太尼的麻醉方案,在稳定血流动力学指标、保护心脏功能、加快术后康复、降低术后谵妄方面的效果,优于采用丙泊酚、瑞芬太尼静脉麻醉。

Objective:To analyze the influences of sevoflurane combined with propofol and remifentanil anesthesia on hemodynamic indexes and postoperative delirium in elderly patients with coronary heart disease(CHD)undergoing laparoscopic surgery.Methods:One hundred and twenty elderly CHD patients who underwent laparoscopic gastrointestinal surgery in Jincheng People’s Hospital from January 2020 to December 2020 were selected as the research subjects.The patients were randomly divided into the study group(60 cases)and the control group(60 cases),sevoflurane inhalation combined with propofol and remifentanil intravenous drip was used for anesthesia maintenance in the study group,and propofol and remifentanil intravenous drip was used for anesthesia maintenance in the control group.The mean arterial pressure(MAP),heart rate(HR),cardiac output(CO),cardiac index(CI),systemic vascular resistance(SVR),left ventricular work(LCW)and blood oxygen saturation(SpO_(2))were monitored at the time points of before anesthesia induction(T_(0)),during endotracheal intubation(T_(1)),10 min after pneumoperitoneum establishment(T_(2))and extubation(T_(3)).The incidences of perioperative cardiovascular events,the application of vasoactive drugs,the recovery indexes and the incidence of postoperative delirium were compared between the two groups.Results:At T_(1),T_(2)and T_(3)time points,the levels of MAP,CO,CI,SVR and LCW in the study group were higher than those in the control group(P<0.05),and the level of HR was lower than that in the control group(P<0.05).The incidence of perioperative myocardial ischemia and the proportion of application of nitroglycerin and esmolol in the study group were lower than those in the control group(P<0.05).The recovery time of spontaneous breathing,the time of extubation,the time for eye opening,the time for speech response,the time for directional force recovery in the study group were shorter than those in the control group(P<0.05).The incidence of postoperative delirium was lower than that in the control group(P<0.05).Conclusion:In the laparoscopic gastrointestinal surgery for elderly patients with CHD,the anesthesia scheme of sevoflurane combined with propofol and remifentanil is better than propofol and remifentanil intravenous anesthesia in stabilizing hemodynamic indexes,protecting cardiac function,accelerating postoperative rehabilitation and reducing postoperative delirium.