全凭静脉全麻与静脉复合七氟烷吸入全麻对高龄患者的安全性对比

Study of safety of inhaled anesthesia with intravenous sevoflurane combined with intravenous general anesthesia for elderly patients

目的全凭静脉全麻与静脉复合七氟烷吸入全麻对高龄手术麻醉患者的安全性对比。方法研究选取龙华医院2015年1月—2017年1月间高龄手术患者100例进行研究。随机分为2组,A组患者50例,B组患者50例;A组患者使用静脉复合七氟烷吸入麻醉;B组患者使用丙泊酚全凭静脉麻醉。研究收集相关信息对比两组患者术中以及术后麻醉安全性状态,并进行对比分析。采用SPSS18.0统计软件包分析处理数据。结果本研究中2组患者基本特征比较差异无统计学意义,(P>0.05)。年龄分布、性别分布以及BMI分布和手术种类的分布均充分可比。研究中2组受试对象手术中麻醉时间以及瑞芬太尼的使用差别均无统计学意义,(P>0.05);术后睁眼时间以及术后拔管时间均可见吸入麻醉组相对更长,两组差别有统计学意义,(P<0.05)。本研究中收集患者术前肝功能水平,以ALT和AST水平为代表,术后水平减低的评价标准为出现ALT和/或AST水平增加;肾功能水平以Cr和BUN水平来判定,研究中的术后水平减低评价标准为出现Cr和/或BUN水平增加。术后12 h测定结果表明,A组中肝肾功能水平减低的发生比例分别为52.00%和36.00%,分别高于B组的出现比例(分别为24.00%和22.00%),差别均有统计学意义,(P<0.05);认知功能评价结果表明,与术前比较,2组患者术后1 h MMSE评分均见得分水平低于术前水平,但是其中吸入麻醉组的水平要较全凭静脉麻醉组更低,差别均有统计学意义,(P<0.05);术后12 h 2组患者MMSE评分水平均逐渐恢复至术前相当水平,差别无统计学意义,(P>0.05)。结论对于高龄手术全麻患者来说,全凭静脉麻醉在睁眼时间以及拔管时间相对更短,在肝肾毒性以及对认知的影响方面均优于吸入麻醉组。

Objective To compare the safety of intravenous anesthesia with intravenous sevoflurane combined with general anesthesia in elderly patients undergoing surgical anesthesia.Methods A total of 100 elderly patients undergoing surgery between January 2015 and January 2017 were selected for study.Randomly divided into two groups,50 patients in group A and 50 patients in group B;Patients in group A were treated with intravenous sevoflurane inhalation anesthesia;Patients in group B were treated with propofol intravenous anesthesia.The study collected relevant information and compared the intraoperative and postoperative anesthesia safety status between the two groups of patients and conducted a comparative analysis.SPSS18.0 statistical software package analysis and processing data.Results There was no difference in the basic characteristics between the two groups in this study,P>0.05.The age distribution,gender distribution,distribution of BMI,and distribution of surgical types were all comparable.There were no statistically significant differences in the anesthetic time and the use of remifentanil between the two groups during the study.The time of eyelid opening and the duration of extubation were similarly longer in the inhalation anesthesia group.There were differences between the two groups.Statistical significance,P<0.05.In this study,the preoperative liver function was collected and represented by ALT and AST levels.The standard for the reduction of postoperative level was the increase of ALT and/or AST levels;The renal function level was determined by Cr and BUN levels.The standard for postoperative reduction in the level of assessment is an increase in Cr and/or BUN levels.The 12-hour postoperative results showed that the proportion of liver and kidney function decreased in group A was 52.00%and 36.00%,respectively,which was higher than that of group B(24.00%and 22.00%,respectively).The difference was statistically significant.Significance,P<0.05;Cognitive function evaluation results showed that,compared with preoperative,the MMSE scores in both groups were lower than the preoperative level at 1 hour postoperatively,but the level of inhalation anesthesia group was higher than that of total intravenous anesthesia.The group was lower and the difference was statistically significant(P<0.05).After 12 hours of operation,the MMSE scores of the two groups gradually returned to preoperative levels.The difference was not statistically significant(P>0.05).Conclusion For elderly patients undergoing general anesthesia,total intravenous anesthesia is more effective in the duration of eyelid opening and extubation,and it is superior to the inhalation anesthesia group in terms of hepato-nephrotoxicity and effects on cognition.