静吸复合麻醉与单纯静脉麻醉在老年腹腔镜全子宫切除术中对患者认知功能、血流动力学及应激指标的影响

Effects of intravenous anesthesia and intravenous anesthesia on cognitive fiinctioii,hemodynamics and stress indexes in elderly patients undergoing laparoscopic total hysterectomy

目的研究老年腹腔镜全子宫切除术中应用静吸复合麻醉与单纯静脉麻醉的效果及其对患者认知功能、血流动力学及应激指标的影响。方法选取50例接受腹腔镜全子宫切除术治疗的老年患者,按照随机数字表法将其分为对照组与研究组,每组25例。对照组应用单纯静脉麻醉,研究组应用静吸复合麻醉。对比两组术中各时间点[麻醉诱导前(T_(0))、气腹建立后30 min(T_(1))、术毕(T_(2))]血流动力学指标及手术前后应激指标水平、蒙特利尔认知评估量表(MoCA)评分。结果两组术中心率(HR)及平均动脉压(MAP)水平均呈先升高后降低趋势,研究组T_(1-2)时HR及MAP水平低于对照组(P<0.05)。两组术后6 h及术后12 h的肾上腺素(AD)水平低于麻醉诱导前,研究组术后6 h及术后12 h的AD水平低于对照组(P<0.05)。研究组术后MoCA评分(28.56±0.95)分,高于对照组的(27.63±0.86)(P<0.05)。结论于老年腹腔镜全子宫切除术中应用静吸复合麻醉可稳定其术中血流动力学,减弱麻醉药物对术后应激反应、认知功能的影响。

Objective To investigate the effects of intravenous anesthesia and intravenous anesthesia on cognitive function,hemodynamics and stress indexes in senile patients undergoing laparoscopic hysterectomy.Methods 50 elderly patients undergoing laparoscopic total hysterectomy were selected and divided into control group and study group according to random number table method,with 25 cases in each group.The control group received intravenous anesthesia alone,and the study group received resting anesthesia combined.The hemodynamic indexes,stress indexes before and after surgery,and scores of montreal cognitive assessment scale(MoCA)were compared between the two groups at various time points during the operation[before anesthesia induction(T_(0)),30 minutes after pneumoperitoneum establishment(T_(1)),after surgery(T_(2))].Results The operative center rate(HR)and mean arterial pressure(MAP)levels of the two groups were firstly increased and then decreased,and the levels of HR and MAP in the study group were lower than those in the control group at T_(1-2)(P<0.05).The level of adrenaline(AD)at 6 h and 12 h after surgery was lower than that before anesthesia induction,and the level of AD in the study group was lower than that in the control group at 6 h and 12 h after surgery(P<0.05).The MoCA score of the study group was(28.56±0.95)points,higher than that of the control group(27.63±0.86)points(P<0.05).Conclusion The application of combined intravenous and inhalation anesthesia in laparoscopic total hysterectomy in the elderly can stabilize the intraoperative hemodynamics and reduce the effects of anesthetic drugs on postoperative stress response and cognitive function.