丙泊酚、七氟烷对老年急性胆囊炎患者苏醒质量及炎症应激的影响

Effects of Propofol and Sevoflurane on Recovery Quality and Inflammatory Stress in Aged Patients with Acute Cholecystitis

目的 丙泊酚、七氟烷对老年急性胆囊炎患者苏醒质量及炎症应激的影响。方法 前瞻性选取2020年4月至2022年12月新乡医学院院第一附属医院收治的86例急性胆囊炎患者,以随机数字表法分组,各43例。两组均行腹腔镜胆囊切除术。A组麻醉维持时吸入2%~3%七氟烷,每分钟靶控输注0.1~0.2μg·kg^(-1)瑞芬太尼。B组麻醉维持时吸入每小时4~6 mg·kg^(-1)丙泊酚,每分钟0.1~0.2μg·kg^(-1)瑞芬太尼。比较两组苏醒质量、不良反应及不同时间点血流动力学[心率(HR)、平均动脉压(MAP)、每搏变异量(SVV)]、炎症指标[白细胞介素-6(IL-6)、IL-8、肿瘤坏死因子-α(TNF-α)]、简易精神状态量表(MMSE)。结果 与B组相比,A组拔管时间、自主呼吸恢复时间缩短(P<0.05);HR、MMSE评分组间、不同时间点及交互作用均有统计学意义(P<0.05);MAP、SVV、IL-6、IL-8、TNF-α组间、不同时间点及交互作用均无统计学意义(P>0.05);苏醒后24 h内,A组不良反应发生率与B组相比,差异无统计学意义(P>0.05)。结论 相比丙泊酚,七氟烷更能维持老年急性胆囊炎患者心率稳定,提高苏醒质量,减轻认知损害。

Objective To investigate the effects of propofol and sevoflurane on recovery quality and inflammatory stress in aged patients with acute cholecystitis.Methods A total of 86 patients with acute cholecystitis admitted to the First Affiliated Hospital of Xinxiang Medical College from April 2020 to December 2022 were prospectively selected and divided into 43 cases in each group by random number table method.Both groups received laparoscopic cholecystectomy,while group A inhaled 2%-3%sevoflurane during anesthesia maintenance,with a target controlled infusion of 0.1-0.2 per minuteμg·kg-1 remifentanil,group B inhaled 4-6 mg·kg-1 per hour propofol during anesthesia maintenance,0.1-0.2 per minuteμg·kg-1 remifentanil.The quality of recovery,adverse reactions,hemodynamics[heart rate(HR),mean arterial pressure(MAP),stroke variation(SVV)],inflammatory markers[interleukin-6(IL-6),IL-8,tumor necrosis factor-α(TNF-α)]and simple mental state scale(MMSE)were compared between the two groups.Results Compared with group B,the extubation time and autonomic respiration recovery time were shorter in group A(P<0.05).The differences between groups in HR and MMSE scores,the differences at different time points,and the interaction effect were statistically significant(P<0.05).The differences between groups in MAP,SVV,IL-6,IL-8 and TNF-α,the differences at different time points,and the interaction effect were not statistically significant(P>0.05).Within 24 hours after awakening,there was no difference in the incidence of adverse reactions between group A and group B(P>0.05).Conclusion Compared with propofol,sevoflurane is better able to maintain stable heart rate,improve quality of awakening,and reduce cognitive impairment in elderly patients with acute cholecystitis.