本文選題：腹腔鏡膽囊切除術(shù) + 老年患者��； 參考：《醫(yī)學(xué)綜述》2016年10期

【摘要】：目的探討丙泊酚與瑞芬太尼靜吸復(fù)合麻醉對(duì)老年腹腔鏡下膽囊切除患者術(shù)后認(rèn)知功能的影響。方法選擇2014年2~12月上海市交通大學(xué)附屬同仁醫(yī)院治療的90例行腹腔鏡下膽囊切除術(shù)的老年患者為研究對(duì)象,按抽簽法隨機(jī)分為觀察組和對(duì)照組,各45例。觀察組患者采用丙泊酚與瑞芬太尼靜脈麻醉復(fù)合吸入進(jìn)行麻醉(1.5~2.5 mg/kg丙泊酚、2μg/kg的瑞芬太尼以及0.1 mg/kg維庫溴銨),對(duì)照組則采用丙泊酚與瑞芬太尼靶控靜脈麻醉(瑞芬太尼血漿靶的濃度設(shè)置為4.0μg/L,丙泊酚血漿靶濃度設(shè)置為3.5 mg/L)。比較兩組患者在治療中的拔管時(shí)間、手術(shù)時(shí)間以及蘇醒時(shí)間等基本情況,比較兩組患者手術(shù)前后的簡易精神狀態(tài)評(píng)價(jià)量表(MMSE)評(píng)分、警覺-鎮(zhèn)靜評(píng)分(OAAS),術(shù)后調(diào)查分析兩組患者對(duì)治療中麻醉情況的滿意度。結(jié)果觀察組患者蘇醒時(shí)間、自主恢復(fù)呼吸時(shí)間以及定向力恢復(fù)時(shí)間均短于對(duì)照組[(6.4±2.6)min比(7.7±2.3)min,(2.4±0.9)min比(6.2±1.3)min,(8.8±2.5)min比(11.7±3.1)min],差異有統(tǒng)計(jì)學(xué)意義(P0.05)。對(duì)照組在術(shù)后1 h、3 h、1 d的MMSE評(píng)分表現(xiàn)為先下降后升高的趨勢,而觀察組在術(shù)后1 h、3 h、1 d的MMSE評(píng)分無明顯變化,觀察組患者在拔管后1 h、3 h以及1 d的評(píng)分均高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。兩組患者在術(shù)后即刻、術(shù)后1 h及術(shù)后3 h的OAAS評(píng)分均呈上升趨勢,觀察組各時(shí)間點(diǎn)均高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。觀察組患者的總滿意度高于對(duì)照組[97.8%(44/45)比84.4%(38/45)],差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論老年腹腔鏡下膽囊切除術(shù)應(yīng)用丙泊酚與瑞芬太尼靜吸復(fù)合麻醉,對(duì)患者術(shù)后認(rèn)知功能影響較小,麻醉恢復(fù)時(shí)間短,值得推廣應(yīng)用。
[Abstract]:Objective to investigate the effect of propofol and remifentanil combined anesthesia on cognitive function of elderly patients undergoing laparoscopic cholecystectomy. Methods 90 elderly patients who were treated with laparoscopic cholecystectomy in Tongren Hospital affiliated to Shanghai Jiaotong University from February to December 2014 were randomly divided into observation group (n = 45) and control group (n = 45). Patients in the observation group were anesthetized by intravenous anesthesia of propofol and remifentanil (remifentanil 2 渭 g/kg of 1.5 mg/kg and vecuronium 0. 1 mg/kg), while those in the control group were anesthetized by target controlled intravenous anesthesia with propofol and remifentanil (remifene). The target concentration of ternitine was 4.0 渭 g / L, and that of propofol was 3.5 mg / L. The extubation time, operation time and recovery time were compared between the two groups, and the MMSE scores before and after operation were compared between the two groups. Alertness-sedation score (OAAS) was used to investigate the patients' satisfaction with anesthesia after operation. Results the recovery time, spontaneous recovery time and directional recovery time in the observation group were significantly shorter than those in the control group [(6.4 鹵2.6) min vs (7.7 鹵2.3) min, (2.4 鹵0.9) min vs (6.2 鹵1.3) min, (8.8 鹵2.5) min vs (11.7 鹵3.1) min] (P0.05). The MMSE scores of the control group decreased first and then increased at 1 hour and 3 hours after operation, while the MMSE scores of the observation group showed no significant change at 1 hour or 3 hours after extubation. The MMSE scores in the observation group were higher than those in the control group at 1 hour and 1 day after extubation. The MMSE scores in the observation group were higher than those in the control group at 1 hour and 1 day after extubation. The difference was statistically significant (P0.05). The OAAS scores of the two groups showed an upward trend immediately after operation 1 hour and 3 hours after operation. The OAAS scores in the observation group were higher than those in the control group at each time point the difference was statistically significant (P0.05). The total satisfaction of patients in the observation group was significantly higher than that in the control group [97.8% (44 / 45) vs 84.4% (38 / 45)] (P0.05). Conclusion the combined anesthesia of propofol and remifentanil in elderly laparoscopic cholecystectomy has little effect on postoperative cognitive function and short recovery time, so it is worth popularizing.
【作者單位】： 上海市交通大學(xué)附屬同仁醫(yī)院麻醉科;
【分類號(hào)】：R614

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