不同浓度七氟醚联合瑞芬太尼对腹腔镜胆囊切除术患者应激反应和认知功能的影响

Effects of Different Concentrations of Sevoflurane Combine with Remifentanil on Stress Response and Cognitive Function in Patients Undergoing Laparoscopic Cholecystectomy

目的:探讨不同浓度七氟醚联合瑞芬太尼对腹腔镜胆囊切除术(LC)患者应激反应和认知功能的影响。方法:选择2022年6月至2022年12月期间在扬州大学附属医院接受LC的患者120例,按照随机数字表法将患者分为低浓度组[1.0最低肺泡有效浓度(MAC)七氟醚联合瑞芬太尼,n=60]和高浓度组(1.5MAC七氟醚联合瑞芬太尼,n=60)。对比两组血流动力学指标[心率(HR)、收缩压(SBP)、舒张压(DBP)]、苏醒质量、应激反应指标[超氧化物歧化酶(SOD)、丙二醛(MDA)、总抗氧化能力(T-AOC)]、认知功能和不良反应发生情况。结果:低浓度组插管后即刻(T1)~拔管时(T5)时间点HR、SBP、DBP高于高浓度组(P<0.05)。低浓度组的自主呼吸时间、苏醒时间、拔管时间、定向力恢复时间短于高浓度组(P<0.05)。两组术后1h SOD、T-AOC均下降,但低浓度组高于高浓度组(P<0.05)。两组术后1h MDA升高,但低浓度组低于高浓度组(P<0.05)。低浓度组术后6 h、术后12 h、术后24 h简易精神状态检查量表(MMSE)评分高于高浓度组(P<0.05)。两组不良反应发生率组间对比未见差异(P>0.05)。结论:与1.5MAC七氟醚相比,1.0MAC七氟醚联合瑞芬太尼应用于LC患者的效果更好,可保持血流动力学平稳,有效控制机体的应激反应,同时还可减轻认知功能影响,提高苏醒质量。

Objective:To investigate the effects of different concentrations of sevoflurane combine with remifentanil on stress response and cognitive function in patients undergoing laparoscopic cholecystectomy(LC).Methods:120 patients who underwent LC in the Affiliated Hospital of Yangzhou University from June 2022 to December 2022 were selected,patients were divided into low concentration group[1.0 minimum alveolar effective concentration(MAC)sevoflurane combined with remifentanil,n=60]and high concentration group(1.5 MAC sevoflurane combined with remifentanil,n=60)according to the random number table method.The hemodynamic indexes[heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP)],recovery quality,stress response indexes[superoxide dismutase(SOD),malondialdehyde(MDA),total antioxidant capacity(T-AOC)],cognitive function and adverse reactions were compared between two groups.Results:HR,SBP and DBP at Immediately after intubation(T1)-pulling out the pipe time(T5)in low concentration group were higher than those in high concentration group(P<0.05).The spontaneous breathing time,recovery time,extubation time and orientation recovery time in low concentration group were shorter than those in high concentration group(P<0.05).SOD and T-AOC decreased in both groups at 1 h after operation,but low concentration group was higher than that of high concentration group(P<0.05).MDA increased in both groups at 1 h after operation,but low concentration group was lower than that of high concentration group(P<0.05).The mini mental status examination(MMSE)score in low concentration group was higher than that in high concentration group at 6 h after operation,12 h after operation and 24 h after operation(P<0.05).There was no difference in the incidence of adverse reactions between two groups(P>0.05).Conclusion:Compared with 1.5MAC Sevoflurane,1.0MAC Sevoflurane combined with remifentanil has a better effect in patients with LC,which can maintain stable hemodynamics,effectively control the stress response of the body,reduce the impact of cognitive function,and improve the quality of recovery.