【摘要】：目的觀察依托咪酯復(fù)合瑞芬太尼麻醉誘導(dǎo)對老年腹腔鏡手術(shù)患者術(shù)后早期認(rèn)知功能的影響。方法擬行腹腔鏡手術(shù)的老年(年齡60歲)患者180例,將其隨機分為依托咪酯組、瑞芬太尼組和聯(lián)合組各60例。依托咪酯組采用靶控輸注(TCI)依托咪酯進(jìn)行麻醉誘導(dǎo),血漿靶濃度0.4 mg/L;瑞芬太尼組TCI瑞芬太尼,血漿靶濃度2.0 ng/m L;聯(lián)合組TCI瑞芬太尼2.0 ng/m L、依托咪酯0.1~0.3 mg/kg。各組術(shù)中均以芬太尼4μg/kg和阿曲庫銨0.15 mg/(kg·h)持續(xù)泵入維持麻醉。記錄各組手術(shù)時間和睜眼時間。分別于術(shù)前1天及術(shù)后1、12、24、48、72 h進(jìn)行簡易智能量表(MMSE)評分,分別于術(shù)前1天及術(shù)后1、3、5天進(jìn)行韋氏評分量表(WAIS)評分。結(jié)果聯(lián)合組手術(shù)時間短于依托咪酯組、瑞芬太尼組,睜眼時間長于依托咪酯組、瑞芬太尼組(P均0.05)。3組術(shù)后1、12、24 h MMSE評分均低于術(shù)前(P均0.05);聯(lián)合組術(shù)后48、72 h MMSE評分高于依托咪酯組、瑞芬太尼組(P均0.05)。3組術(shù)后1、3、5天WAIS評分均低于術(shù)前(P均0.05);聯(lián)合組術(shù)后3、5天WAIS評分高于依托咪酯組、瑞芬太尼組(P均0.05)。結(jié)論對于行腹腔鏡手術(shù)的老年患者,采用依托咪酯復(fù)合瑞芬太尼麻醉誘導(dǎo)對患者術(shù)后認(rèn)知功能影響較小,優(yōu)于單藥應(yīng)用。
[Abstract]:Objective to observe the effect of etomidate combined with remifentanil anesthesia on early cognitive function in elderly patients undergoing laparoscopic surgery. Methods 180 elderly patients (60 years old) undergoing laparoscopic surgery were randomly divided into etomidate group (n = 60), remifentanil group (n = 60) and combined group (n = 60). Etomidate group was induced by target controlled infusion of etomidate (TCI). Plasma target concentration of remifentanil was 0.4 mg/L; and plasma target concentration of TCI remifentanil was 2.0 ng/m / L in remifentanil group. Combined group TCI remifentanil 2.0 ng/m L, etomidate 0.1 / 0.3 mg/kg. Fentanyl 4 渭 g / kg and atracurium 0.15 mg/ (kg 路h) were used to maintain anesthesia. The operation time and eye opening time were recorded in each group. One day before operation and 1,12,24,48,72 hours after operation, the simplified Intelligence scale (MMSE) was evaluated. The (WAIS) score of Wechsler scale was performed on the first day before the operation and 1,3,5 days after the operation. The patients were divided into two groups: 1 day before operation and 1 day, 3 days and 5 days after operation. Results the operation time in the combined group was shorter than that in the etomidate group, remifentanil group and remifentanil group, and the MMSE scores in the three groups were lower than those before operation at 1,12,24 hours after operation (all P 0.05), and that in the remifentanil group was longer than that in the etomidate group and remifentanil group. The MMSE scores in the combined group were higher than those in the etomidate group and remifentanil group at 48,72 hours after operation, and the WAIS scores in the three groups were lower than those before operation at 1, 3 and 5 days after operation (all P 0.05). The WAIS scores in the combined group were higher than those in the etomidate group and remifentanil group on the 3rd and 5th day after operation. Conclusion Etomidate combined with remifentanil anesthesia induction has little effect on cognitive function in elderly patients undergoing laparoscopic surgery, which is superior to single drug application.
【作者單位】： 陜西煤化集團銅川礦務(wù)局中心醫(yī)院;
【分類號】：R614.2

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本文編號：2443839