异丙酚与七氟醚麻醉对老年输尿管镜手术患者麻醉术后苏醒质量和认知功能影响的比较
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摘要
目的探讨异丙酚与七氟醚麻醉对老年老年输尿管镜手术患者麻醉术后苏醒质量和认知功能影响的比较。方法选取2015年1月～2017年12月择期输尿管镜手术治疗的老年患者80例,分为异丙酚组和七氟醚组各40例,分别采用异丙酚静脉麻醉和七氟醚吸入麻醉。观察两组患者麻醉术后苏醒质量指标,并评估麻醉前(T0)、术后4 h(T1)、术后12 h(T2)及术后24 h(T3)认知功能的变化,并比较两组不良反应情况。结果异丙酚组患者的自主呼吸恢复时间、睁眼时间和拔管时间明显短于七氟醚组(P<0.05)。两组患者T1和T2时MMSE评分均较T0时明显下降(P<0.05);且七氟醚组患者下降幅度较异丙酚组更明显(P<0.05);两组患者T3时MMSE评分均恢复至T0时水平(P>0.05)。观察组与对照组分别出现不良反应3例(7.50%)、5例(12.50%),症状均较轻,两组比较差异无统计学意义(χ2=0.14,P>0.05)。结论与七氟醚吸入麻醉相比,异丙酚静脉麻醉用于老年输尿管镜患者术后具有苏醒速度快、呼吸恢复快、拔管时间早、认知功能影响较少及安全性较好等优点。
Objective To investigate the effects of propofol and sevoflurane anesthesia on the postoperative awakening quality and cognitive function of anesthesia in elderly patients undergoing ureteroscopic surgery. Methods 80 elderly patients with elective ureteroscopy from January 2015 to December 2017 were enrolled. The patients were divided into propofol group and sevoflurane group, with 40 patients in each group. The propofol group and sevoflurane group were treated with propofol intravenous anesthesia and sevoflurane inhalation anesthesia, respectively. The quality of awaken ing after anesthesia was observed in both groups, and the changes in cognitive function before anesthesia(T0), 4 h(T1),12 h(T2) and 24 h(T3) were evaluated, and adverse reactions were compared. Results The spontaneous breathing recovery time, blink time and extubation time were significantly shorter in the propofol group than those in the sevoflurane group(P<0.05). The MMSE scores of T1 and T2 in the two groups were significantly lower than those in T0(P<0.05).The decrease of sevoflurane group was more obvious than that in propofol group(P<0.05). The MMSE scores of the two groups at T3 were restored to that at T0 level(P>0.05). There were 3 cases(7.50%) and 5 cases(12.50%) of adverse reactions in the observation group and the control group. And the symptoms were mild. There was no significant difference between the two groups(χ2=0.14, P>0.05). Conclusion Compared with sevoflurane inhalation anesthesia, propofol intravenous anesthesia is used for elderly ureteroscopy patients with fast recovery, rapid recovery of breathing, early extubation time, less cognitive function and better safety.
Objective To investigate the effects of propofol and sevoflurane anesthesia on the postoperative awakening quality and cognitive function of anesthesia in elderly patients undergoing ureteroscopic surgery. Methods 80 elderly patients with elective ureteroscopy from January 2015 to December 2017 were enrolled. The patients were divided into propofol group and sevoflurane group, with 40 patients in each group. The propofol group and sevoflurane group were treated with propofol intravenous anesthesia and sevoflurane inhalation anesthesia, respectively. The quality of awaken ing after anesthesia was observed in both groups, and the changes in cognitive function before anesthesia(T0), 4 h(T1),12 h(T2) and 24 h(T3) were evaluated, and adverse reactions were compared. Results The spontaneous breathing recovery time, blink time and extubation time were significantly shorter in the propofol group than those in the sevoflurane group(P<0.05). The MMSE scores of T1 and T2 in the two groups were significantly lower than those in T0(P<0.05).The decrease of sevoflurane group was more obvious than that in propofol group(P<0.05). The MMSE scores of the two groups at T3 were restored to that at T0 level(P>0.05). There were 3 cases(7.50%) and 5 cases(12.50%) of adverse reactions in the observation group and the control group. And the symptoms were mild. There was no significant difference between the two groups(χ2=0.14, P>0.05). Conclusion Compared with sevoflurane inhalation anesthesia, propofol intravenous anesthesia is used for elderly ureteroscopy patients with fast recovery, rapid recovery of breathing, early extubation time, less cognitive function and better safety.
引文
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[17]黄典,杨春燕,廖益永,等.不同剂量地佐辛复合七氟醚对上腹部手术患者麻醉效果及血流动力学的影响[J].实用药物与临床,2016,19(10):1273-1276.
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[19]Wei H,Liang G,Yang H,et al.The common inhalational anesthetic isoflurane induces apoptosis via activation of inositol 1,4,5-trisphosphate receptors[J].Anesthesiology,2008,108(2):251-260.
[20]岑盛华,傅海青,梁磊.七氟醚和丙泊酚用于麻醉维持对患者脑氧代谢及认知功能的影响[J].中国生化药物杂志,2017,37(6):177-179,182.
[21]Evered L,Scott DA,Silbert B,et al.Postoperative cognitive dysfunction is independent of type of surgery and anesthetic[J].Anesth Analg,2011,112(5):1179-1185.
[22]Yang H,Liang G,Hawkins BJ,et al.Inhalational anesthetics induce cell damage by disruption of intracellular calcium homeostasis with different potencies[J].Anesthesiology,2008,109(2):243-250.
[23]丁力,俞盛辉,高翔,等.异丙酚对老年患者术后早期认知功能及S100蛋白表达的影响[J].中国现代医生,2012,50(24):95-96,98.
[24]宋晓阳,王焱林,甘国胜,等.丙泊酚麻醉对颅脑外伤手术患者血清NSE含量和术后6个月简易智能量表评分的影响[J].中国康复,2007,22(2),99-101.
[25]Royse CF,Andrews DT,Newman SN,et al.Vorapaxar in acute coronary syndrome patients undergoing coronary artery bypass graft surgery:Subgroup analysis from the TrACER trial[J].Anaesthesia,2013,66(4):290.
[26]Fredriksson A,Ponten ET,Eriksson P.Neonatal exposure to acombination of N-methyl-D-aspartate and gammaaminobutyric acid type A receptor anesthetic agents potentiates apoptotic neurodegeneration and persistent behavioral deficits[J].Anesthesiology,2007,107(3):427-36.
[27]Cattano D,Young C,Straiko MM,et al.Subanesthetic doses of propofol induce neuroapoptosis in the infant mouse brain[J].AnesthAnalg,2008,106(6):1712-1714.
[28]Yu D,Jiang Y,Gao J,et al.Repeated exposure to propofol potentiates neuroapoptosis and long-term behavioral deficits in neonatal rats[J].NeurosciLett,2013,534(1):41-46.
[29]Li J,Han B,Ma X,et al.The effects of propofol on hippocampal caspase-3 and Bcl-2 expression following forebrain ischemia-reperfusion in rats[J].Brain Res,2010,1356(3):11-23.
[30]孙岸灵,梁星宝,陈志敏,等.丙泊酚和七氟烷麻醉对老年患者普通胸外科手术后认知功能的影响[J].吉林医学,2015,36(12):2598-2600.
[2]Browne SM,Halligan PW,Wade DT,et al.Postoperative hypoxia is a contributory factor to cognitive impairment after cardiac surgery[J].Thorac Cardi ovasc Surg,2003,126(4):1062-1064.
[3]Pratico C,Quattrone D,Lucanto T,et al.Drugs of anesthesia acting on central cholinergic systerm many cause postoperative cognitive dysfunction and delimium[J].Med Hypothese,2005,65(5):972-982.
[4]Kalimeris K,Kouni S,Kostopanagiotou G,et al.Cognitive function and oxidative stress after carotid endarterectomy:Comparison of propofol tosevoflurane anesthesia[J].JCardiothorac Vasc Anesth,2013,27(6):1246-1252.
[5]李晓磊,杨晓东,段莹莹.七氟醚复合麻醉对老年髋关节置换患者术后短期认知功能的影响[J].检验医学与临床,2016,13(4):510-512.
[6]贺桂文,汪建.七氟醚麻醉对老年择期手术患者认知功能及血清脑源性神经营养因子抗炎性细胞因子的影响[J].临床药物治疗杂志,2017,15(5):43-47.
[7]常玉林,杨森.异丙酚和七氟醚对老年患者术后认知功能的影响[J].河北医药,2011,33(15):2298-2299.
[8]甘蓉辉,徐丽莉,谢阿奇,等.异氟醚和异丙酚对老年患者术后认知功能的影响[J].西部医学,2011,23(6):1104-1106.
[9]王海滨,孟尽海,邹丽丽.异氟烷和异丙酚对老年非心脏手术后早期认知的影响[J].中国老年学杂志,2014,34(21):6061-6062.
[10]陈转侨.七氟烷和丙泊酚麻醉对老年肺癌患者的影响分析[J].中国现代药物应用,2015,9(15):167-168.
[11]ArarC,Kaya G,Karamanlioglu B,et al.Effects of sevoflurane,isoflurane and propofol infusions on post-operative recovery criteria in geriatric patients[J].The Journal of International Medical Research,2005,33(1):55-60.
[12]Wan Y,Xu J,Meng F,et al.Cognitive decline following major surgery is associated with gliosis,beta-amyloid accumulation,and tauphosphorylation in old mice[J].Crit Care Med,2010,38(11):190-198.
[13]Monk TG,Weldon BC,Garwan CW,et a1.Predictors of cognitive dysfunction after major noncardiac surgery[J].Anesthesiology,2008,108(1):18-30.
[14]于学超,王延国,高鲁渤,等.七氟烷或丙泊酚麻醉对老年肺癌患者术后认知功能的影响[J].天津医科大学学报,2012,18(1):102-105.
[15]Wang JK,Yu LN,Zhang FJ,et al.Postconditioning with sevoflurane protects against focal cerebral ischemia and reperfusion injury via PI3K/Akt pathway[J].Brain Res,2010,1357(2):142-151.
[16]祁爱花,王爱忠.丙泊酚与七氟烷对老年肺癌患者术后认知功能的影响[J].医学综述,2018,24(3):606-616.
[17]黄典,杨春燕,廖益永,等.不同剂量地佐辛复合七氟醚对上腹部手术患者麻醉效果及血流动力学的影响[J].实用药物与临床,2016,19(10):1273-1276.
[18]李晓磊,杨晓东,段莹莹.七氟醚复合麻醉对老年髋关节置换患者术后短期认知功能的影响[J].检验医学与临床,2016,13(4):510-512.
[19]Wei H,Liang G,Yang H,et al.The common inhalational anesthetic isoflurane induces apoptosis via activation of inositol 1,4,5-trisphosphate receptors[J].Anesthesiology,2008,108(2):251-260.
[20]岑盛华,傅海青,梁磊.七氟醚和丙泊酚用于麻醉维持对患者脑氧代谢及认知功能的影响[J].中国生化药物杂志,2017,37(6):177-179,182.
[21]Evered L,Scott DA,Silbert B,et al.Postoperative cognitive dysfunction is independent of type of surgery and anesthetic[J].Anesth Analg,2011,112(5):1179-1185.
[22]Yang H,Liang G,Hawkins BJ,et al.Inhalational anesthetics induce cell damage by disruption of intracellular calcium homeostasis with different potencies[J].Anesthesiology,2008,109(2):243-250.
[23]丁力,俞盛辉,高翔,等.异丙酚对老年患者术后早期认知功能及S100蛋白表达的影响[J].中国现代医生,2012,50(24):95-96,98.
[24]宋晓阳,王焱林,甘国胜,等.丙泊酚麻醉对颅脑外伤手术患者血清NSE含量和术后6个月简易智能量表评分的影响[J].中国康复,2007,22(2),99-101.
[25]Royse CF,Andrews DT,Newman SN,et al.Vorapaxar in acute coronary syndrome patients undergoing coronary artery bypass graft surgery:Subgroup analysis from the TrACER trial[J].Anaesthesia,2013,66(4):290.
[26]Fredriksson A,Ponten ET,Eriksson P.Neonatal exposure to acombination of N-methyl-D-aspartate and gammaaminobutyric acid type A receptor anesthetic agents potentiates apoptotic neurodegeneration and persistent behavioral deficits[J].Anesthesiology,2007,107(3):427-36.
[27]Cattano D,Young C,Straiko MM,et al.Subanesthetic doses of propofol induce neuroapoptosis in the infant mouse brain[J].AnesthAnalg,2008,106(6):1712-1714.
[28]Yu D,Jiang Y,Gao J,et al.Repeated exposure to propofol potentiates neuroapoptosis and long-term behavioral deficits in neonatal rats[J].NeurosciLett,2013,534(1):41-46.
[29]Li J,Han B,Ma X,et al.The effects of propofol on hippocampal caspase-3 and Bcl-2 expression following forebrain ischemia-reperfusion in rats[J].Brain Res,2010,1356(3):11-23.
[30]孙岸灵,梁星宝,陈志敏,等.丙泊酚和七氟烷麻醉对老年患者普通胸外科手术后认知功能的影响[J].吉林医学,2015,36(12):2598-2600.