双腔支气管插管术后不同丙泊酚维持剂量对患者认知功能的影响

Effect of different dosages of propofol used in anesthesia maintenance on the cognitive function after double-lumen bronchial intubation

目的 探究双腔支气管插管术后不同丙泊酚维持剂量对患者认知功能的影响。方法 选择2022年1月至2023年6月双腔支气管插管患者100例作为研究对象,年龄18~60岁,BMI 18~24 kg/m^(2),ASAⅠ~Ⅱ级。采用随机数字表法分为A组33例、B组33例、C组34例。3组麻醉诱导方法相同,麻醉维持阶段A组、B组、C组分别恒速泵注丙泊酚1.0 mg·kg^(-1)·h^(-1)、2.0 mg·kg^(-1)·h^(-1)、3.0 mg·kg^(-1)·h^(-1),调节瑞芬太尼用量控制并维持麻醉中平均动脉压(MAP)比其基础MAP降低5%左右。比较观察3组患者MAP、心率(HR)、血氧饱和度(SpO_(2))等血流动力学指标变化,同时观察患者气道峰压(Ppeak)、平均气道压(Pmean)、呼出潮气量(TV)、肺动态顺应性(CLdyn)等呼吸指标变化,观察3组患者认知功能(MMSE评分)变化及不良反应。结果 3组均达到维持MAP,控制MAP比基础值降低0~10%,维持效果评级均达到Ⅰ级。3组患者在T0~T3时的MAP、HR水平比较,差异无统计学意义(P>0.05),T0时3组患者SpO_(2)水平相当,但T1~T3时3组比较,C组SpO_(2)稍高于A、B组(P<0.05)。3组患者在T0时的Ppeak、Pmean、TV、CLdyn水平比较,差异无统计学意义(P>0.05);T1~T3时,B组、C组Ppeak、Pmean水平低于A组(P<0.05),B、C组比较差异无统计学意义(P>0.05);C组TV、CLdyn水平高于A、B组(P<0.05),A、B组比较差异无统计学意义(P>0.05)。3组术后相关不良反应发生率差异无统计学意义(P>0.05)。术前至术后72 h, 3组患者MMSE评分呈先下降再上升趋势,但是4个时刻组间比较均无明显差异(P>0.05)。结论 3.0 mg·kg^(-1)·h^(-1)丙泊酚维持剂量能够保持更好的潮气量和肺顺应性,对维持血流动力学稳定更为理想。

Objective To explore the effect of different dosages of propofol used in anesthesia maintenance on the cognitive function after double-lumen bronchial intubation.Methods Ninety-three patients,with 18-60 years of age,body mass index(BMI)of 18-24kg/m^(2),and the American Society of Anesthesiologists(ASA)physical status classification ofⅠ-Ⅱ,who were treated with double-lumen bronchial intubation in our hospital between January 2022 and June 2023 were selected as the study subjects.They were randomly assigned into group A(n=33),group B(n=33)and group C(n=34),with the same regimen of anesthesia induction.For maintaining anesthesia,pumping infusion of propofol at 1.0mg·kg^(-1)·h^(-1),2.0mg·kg^(-1)·h^(-1) and 3.0mg·kg^(-1)·h^(-1) at a constant rate was performed in three groups,respectively.Remifentanil dose was adjusted to maintain the mean arterial pressure(MAP)decreased by 5%of baseline.Changes in hemodynamic indicators(MAP,heart rate[HR],and oxygen saturation[SpO_(2)]),respiratory indicators(peak airway pressure[Ppeak],mean airway pressure[Pmean],tidal volume of expiration[TV],and pulmonary dynamic compliance[CLdyn]),cognitive function(the Mini-Mental State Examination[MMSE]score)and adverse events were compared among the three groups.Results Patients in tll three groups achieved a MAP decreased by 0^(-1)0%of baseline during anesthesia maintenance,with the maintenance effect of gradeⅠ.There were no significant differences in the MAP and HR at T0-T3 among the three groups(P>0.05).SpO_(2) at T0 was comparable among the three groups,but significantly higher in group C than group A and B at T1-T3(P<0.05).There were no significant differences in Ppeak,Pmean,TV and CLdyn at T0 among the three groups(P>0.05).At T1-T3,Ppeak and Pmean of group B and C were significantly lower than those of group A(P<0.05),but comparable between group B and C(P>0.05).TV and CLdyn in group C were significantly higher than those of group A and B(P<0.05),but comparable between group A and B(P>0.05).No significant difference was detected in the incidence of adverse events among the three groups(P>0.05).From preoperative to 72h postoperatively,the MMSE scores in the three groups first declined and then increased,without a significant difference at the four time points(P>0.05).Conclusion The maintenance dose of propofol at 3.0mg·kg^(-1)·h^(-1) can maintain better tidal volume and lung compliance,which is more ideal for maintaining hemodynamic stability.