七氟烷与丙泊酚对腹腔镜手术患者认知功能、呼吸循环以及应激反应的影响

Effects of Sevoflurane and Propofol on Cognitive Function,Respiration and Circulation and Stress Response in Patients Undergoing Laparoscopic Surgery

目的:探讨七氟烷与丙泊酚对腹腔镜手术患者认知功能、呼吸循环以及应激反应的影响。方法:选取2021年1月~2022年1月期间于某院进行腹腔镜手术的116例患者作为研究对象,按照随机数字表法分为丙泊酚组和七氟烷组,每组58例。丙泊酚组患者采用丙泊酚乳状注射液麻醉,七氟烷组患者采用吸入用七氟烷麻醉。比较两组患者一般指标(术中输血量、麻醉起效时间及呼吸恢复时间)、呼吸循环功能[心率(HR)、平均动脉压(MAP)及血氧饱和度(SO_(2))]、应激相关指标[血糖、血浆肾上腺素、促肾上腺皮质激素(ACTH)、皮质醇]、认知功能[神经元特异性烯醇化酶(NSE)、简易智力状态检查量表(MMSE)]及并发症发生情况。结果:两组患者术中输血量、麻醉起效时间比较均无统计学差异(P>0.05);七氟烷组患者呼吸恢复时间短于丙泊酚组(P<0.05);两组患者麻醉诱导前、麻醉诱导后、麻醉持续10min、麻醉持续20min、麻醉持续30min的HR、MAP及SO_(2)比较均无统计学差异(P>0.05),且不同时间点组内比较均无统计学差异(P>0.05);七氟烷组患者术后即刻、术后6h、术后24h及术后48h的血糖、血浆肾上腺素、ACTH及皮质醇水平均低于丙泊酚组(P<0.05);术后6h、术后24h及术后48h血清NSE水平均高于丙泊酚组(P<0.05),MMSE评分低于丙泊酚组(P<0.05);两组患者术后并发症发生率比较无统计学差异(P>0.05)。结论:进行腹腔镜手术时,采用七氟烷与丙泊酚麻醉对老年患者呼吸循环的影响无统计学差异,丙泊酚对患者的认知功能影响较小,七氟烷抑制机体应激反应的效果更佳。

Objective:To investigate the effects of sevoflurane and propofol on cognitive function,respiration and circulation and stress response in patients undergoing laparoscopic surgery.Methods:A total of 116 patients undergoing laparoscopic surgery in a hospital from January 2021 to January 2022 were divided into the propofol group and sevoflurane group by random number table method,with 58 patients in each group.The propofol group was anesthetized with propofol injectable emulsion,and the sevoflurane group was anesthetized with sevoflurane for inhalation.The general indexes(the amount of intraoperative blood transfusion,onset time of anesthesia and respiratory recovery time),respiratory and circulatory functions[heart rate(HR),mean arterial pressure(MAP)and oxygen saturation(SO_(2))],stress-related indexs[blood glucose,plasma adrenaline,adrenocorticotropic hormone(ACTH)and cortisol],cognitive function[neuron specific enolase(NSE),mini-mental state examination(MMSE)]and complications were observed between the two groups.Results:There was no statistically significant difference in the amount of intraoperative blood transfusion or the onset time of anesthesia between the two groups(P>0.05).The respiratory recovery time in the sevoflurane group was shorter than that in the propofol group(P<0.05).There was no statistically significant difference in HR,MAP or SO_(2) between the two groups before anesthesia induction,after anesthesia induction,at 10min after induction,at 20min after induction or at 30min after induction(P>0.05),without statistically significant difference across timepoints between the two groups(P>0.05).The levels of blood glucose,plasma adrenaline,ACTH and cortisol in the sevoflurane group were lower than those in the propofol group immediately after surgery,and at 6h,24h and 48h after the surgery(P<0.05).The serum NSE level in the sevoflurane group was higher than that in the propofol group at 6h,24h and 48h after surgery(P<0.05),while the MMSE score in the sevoflurane group was lower than that in the propofol group(P<0.05).There was no statistically significant difference in the incidence of postoperative complications between the two groups(P>0.05).Conclusion:There is no significant difference in respiratory and circulatory functions between anesthesia with sevoflurane and propofol in elderly patients undergoing laparoscopic surgery,but propofol has less effect on cognitive function,and sevoflurane is superior in inhibiting stres response.