地氟烷联合丙泊酚对老年糖尿病患者Whipple术术后精神状态的影响

Effect of desflurane combined with propofol on postoperative mental state in elderly diabetic patients undergoing Whipple’s operation

目的探讨地氟烷联合丙泊酚对老年糖尿病患者Whipple术术后精神状态的影响。方法择期行Whipple术的老年糖尿病患者90例随机均分为三组,A、B和C组麻醉维持分别采用吸入地氟烷、静脉泵入丙泊酚和地氟烷联合丙泊酚静吸复合麻醉。比较三组入手术室后(T0)以及术后6 h(T1)、12 h(T2)和48 h(T3)时的血糖、血浆神经元特异性烯醇化酶(NSE)和S-100β蛋白水平以及T1~T3时的VAS疼痛评分、9条目患者健康问卷(PHQ-9)评分和Ramsay镇静评分,并观察术后麻醉恢复室内不良反应发生情况。结果与C组相比,A、B组T1~T3时的VAS疼痛评分、PHQ-9评分以及血浆NSE、S-100β蛋白水平较高,T1~T2时的Ramsay镇静评分较低(P<0.05)。三组各时间点血糖水平差异均无统计学意义(P>0.05)。A、B组患者术后躁动发生率高于C组(P<0.05)。结论与单用地氟烷或丙泊酚相比,行Whipple术的老年糖尿病患者采用地氟烷联合丙泊酚静吸复合麻醉的术后精神状态更佳。

Objective To observe the effect of desflurane combined with propofol on postoperative mental state in elderly diabetic patients undergoing Whipple’s operation.MethodsNinety elderly diabetic patients undergoing Whipple’s operation were equally randomized into three groups.Anesthesia was maintained by inhalation of desflurane(group A),intravenous pumping of propofol(group B)and a combination of desflurane and propofol(group C),respectively.The levels of blood glucose,plasma neuron specific enolase(NSE)and S-100βprotein were detected after entering the operating room(T0)and at 6 hours(T1),12 hours(T2),and 48 hours(T3)after operation.VAS pain score,patient health questionnaire-9(PHQ-9)score and Ramsay sedation score at T1,T2 and T3 were compared among the three groups.Adverse response in PACU was recorded as well.Results Compared with group C,VAS pain score,PHQ-9 score and plasma levels of NSE and S-100βprotein at T1,T2 and T3 were increased and Ramsay sedation score at T1 and T2 was decreased in groups of A and B(P<0.05).There was no significant difference in blood glucose level among the three groups at each time point(P>0.05).The incidence of postoperative agitation in groups of A and B was higher than that in group C(P<0.05).Conclusion The postoperative mental state after Whipple’s operation is better in the elderly diabetic patients anesthetized with desflurane combined with propofol than with desflurane or propofol alone.