[1]孙 强,佘丽丽,黄敏红.全麻腹腔镜手术对老年腹部手术患者血流动力学、镇静效果及认知功能的影响[J].医学信息,2023,36(23):46-49.[doi:10.3969/j.issn.1006-1959.2023.23.011]
　SUN Qiang,SHE Li-li,HUANG Min-hong.Effects of General Anesthesia Laparoscopic Surgery on Hemodynamics,Sedative Effect and Cognitive Function in Elderly Patients Undergoing Abdominal Surgery[J].Journal of Medical Information,2023,36(23):46-49.[doi:10.3969/j.issn.1006-1959.2023.23.011]
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全麻腹腔镜手术对老年腹部手术患者血流动力学、镇静效果及认知功能的影响()
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医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
36卷
期数:
2023年23期
页码:
46-49
栏目:
论著
出版日期:
2023-12-01

文章信息/Info

Title:
Effects of General Anesthesia Laparoscopic Surgery on Hemodynamics,Sedative Effect and Cognitive Function in Elderly Patients Undergoing Abdominal Surgery
文章编号:
1006-1959（2023）23-0046-04
作者:
孙 强; 佘丽丽; 黄敏红
（新干县人民医院普外科，江西 新干 331300）
Author(s):
SUN Qiang; SHE Li-li; HUANG Min-hong
(General Surgery Department of Xingan County People’s Hospital,Xingan 331300,Jiangxi,China)
关键词:
腹部手术; 老年患者; 全身麻醉; 腹腔镜手术; 血流动力学; 镇静效果; 认知功能
Keywords:
Abdominal surgery; Elderly patients; General anesthesia; Laparoscopic surgery; Hemodynamics; Sedative effect; Cognitive function
分类号:
R614
DOI:
10.3969/j.issn.1006-1959.2023.23.011
文献标志码:
A
摘要:
目的 分析全麻腹腔镜手术对老年腹部手术患者血流动力学、镇静效果及认知功能的影响。方法 以2020年1月-2022年6月于新干县人民医院行腹部手术治疗的66例老年患者为研究对象，采用随机数字表法分为A组（33例）与B组（33例）。两组均接受全麻腹腔镜手术治疗，A组选择全凭静脉全麻，B组采用静吸复合全麻，比较两组麻醉前（T0）、全麻诱导插管后（T1）、气腹建立后60 min（T2）、苏醒后（T3）的血流动力学指标[平均动脉压（MAP）、血氧饱和度（SpO2）、心率（HR）]、镇静效果（麻醉起效时间、Ramsay镇静评分）、苏醒时间（自主呼吸恢复时间、睁眼时间、拔管时间、定向力恢复时间）、认知功能[简易精神状态检查量表（MMSE）评分]及不良反应。结果 两组T1、T2时点MAP、SpO2水平低于T0时点，HR高于T0时点，但A组T1、T2时点MAP、SpO2水平高于B组，HR低于B组，差异有统计学意义（P＜0.05）。A组麻醉起效时间短于B组（P＜0.05），但两组Ramsay镇静评分比较，差异无统计学意义（P＞0.05）。A组自主呼吸恢复时间、睁眼时间、拔管时间、定向力恢复时间短于B组（P＜0.05）。两组术后24h的MMSE评分低于术前，但A组MMSE评分高于B组（P＜0.05），而两组术后72 h的MMSE评分比较，差异无统计学意义（P＞0.05）。A组不良反应发生率小于B组（P＜0.05）。结论 全麻腹腔镜手术在老年腹部手术患者中具有较高可行性，其中全凭静脉全麻与静吸复合全麻均具有良好镇静效果，但前者对患者血流动力学及认知功能的影响更小，麻醉起效时间及苏醒时间更短，不良反应更少，更适用于老年患者。
Abstract:
Objective To analyze the effects of general anesthesia laparoscopic surgery on hemodynamics, sedation and cognitive function in elderly patients undergoing abdominal surgery.Methods A total of 66 elderly patients who underwent abdominal surgery in Xingan County People’s Hospital from January 2020 to June 2022 were selected as the research objects, and they were divided into group A (33 patients) and group B (33 patients) by random number table method. Both groups received laparoscopic surgery under general anesthesia. Group A received total intravenous anesthesia, and group B received combined intravenous and inhalation anesthesia. The hemodynamic indexes [mean arterial pressure (MAP), oxygen saturation (SpO2), heart rate (HR)]before anesthesia (T0), after general anesthesia induction and intubation (T1), 60 min after pneumoperitoneum establishment (T2), and after recovery (T3), sedative effect (onset time of anesthesia, Ramsay sedation score), recovery time (spontaneous breathing recovery time, eye opening time, extubation time, orientation recovery time), cognitive function [Mini-mental State Examination (MMSE) score] and adverse reactions were compared between the two groups.Results The levels of MAP and SpO2 at T1 and T2 in the two groups were lower than those at T0, and HR was higher than that at T0, but the levels of MAP and SpO2 at T1 and T2 in group A were higher than those in group B, and HR was lower than that in group B, the differences were statistically significant (P<0.05). The onset time of anesthesia in group A was shorter than that in group B (P<0.05), but there was no significant difference in Ramsay sedation score between the two groups (P>0.05).The spontaneous breathing recovery time, eye opening time, extubation time and orientation recovery time in group A were shorter than those in group B (P<0.05). The MMSE score of the two groups at 24 h after operation was lower than that before operation, but the MMSE score of group A was higher than that of group B(P<0.05), while there was no significant difference in MMSE score between the two groups at 72 h after operation (P>0.05). The incidence of adverse reactions in group A was lower than that in group B (P<0.05).Conclusion Laparoscopic surgery under general anesthesia is feasible in elderly patients undergoing abdominal surgery. Both total intravenous anesthesia and combined intravenous and inhalation anesthesia have good sedative effects, but the former has less influence on hemodynamics and cognitive function, shorter anesthesia onset time and recovery time, less adverse reactions, and is more suitable for elderly patients.

参考文献/References:

[1]陈雪迎,陈权.全麻腹腔镜手术对老年腹部手术患者血流动力学、镇静效果及认知功能的影响[J].陕西医学杂志,2022,51(10):1235-1239.[2]臧宝江.老年患者采用不同麻醉方式发生术后认知功能障碍的对比分析[J].中国医师杂志,2018,20(9):1416-1417.[3]项明方,杨韩,徐迹,等.不同麻醉方式对胃肠肿瘤患者全麻术后认知功能的影响[J].临床外科杂志,2017,25(2):149-152.[4]曾丽蓉,郭瑞,许锦雄,等.静吸复合麻醉与瑞芬太尼和丙泊酚复合全凭静脉麻醉对老年肺部肿瘤开胸手术患者术后认知功能的影响[J].中国医药,2018,13(12):1835-1838.[5]刘叶,李红,刘枝,等.右美托咪定辅助全身麻醉对老年妇科腹腔镜手术患者术后炎症反应和认知功能障碍影响[J].临床误诊误治,2021,34(5):96-101.[6]齐英军,冯英博.全身麻醉复合硬膜外阻滞对行腹腔镜手术老年直肠癌患者的影响研究[J].癌症进展,2021,19(1):85-87.[7]叶林阳,聂洋洋,王庆祥,等.不同麻醉方式对老年腹部手术患者术后肺功能和炎症指标的影响[J].中华医院感染学杂志,2020,30(1):91-95.[8]陈宝霞,林程程,郑晓彬.全身麻醉复合腰硬联合麻醉对腹腔镜手术患者术后疼痛程度与麻醉复苏的影响[J].中国医刊,2020,55(11):1238-1241.[9]安慎通,皇甫加文,闵昱源.全麻腹腔镜手术对老年直肠癌患者术后认知功能的影响及危险因素分析[J].海南医学,2020,31(9):1149-1151.[10]边长荣,王冬梅.全身麻醉复合硬膜外麻醉与静吸复合全身麻醉在腹腔镜子宫切除术中应用观察[J].贵州医药,2020,44(6):898-900.[11]林华赋,程芳,黄启祥.老年患者全身麻醉腹腔镜手术血压脉搏波指数变化的研究[J].中国医师杂志,2018,20(2):279-281.[12]张宜林,谢小娟,邵寒俏.不同的全身麻醉方式对行消化道肿瘤腹腔镜手术的老年患者术后早期认知功能的影响[J].实用癌症杂志,2020,35(3):434-437.[13]肖俊,张洁.不同麻醉方式对老年腹腔镜下手术患者应激反应、神经功能及胃肠道功能的影响[J].海南医学,2020,31(5):618-621.[14]陈靖军,赵向波,勾志静,等.静吸复合麻醉与单纯静脉麻醉对老年子宫肌瘤腹腔镜切除术患者认知功能及应激指标影响[J].中国计划生育学杂志,2020,28(1):76-79.[15]钟照明,曹磊,姚立群.静吸复合麻醉与全凭静脉麻醉对老年腹腔镜子宫肌瘤切除术患者早期认知功能的影响[J].中国医刊,2022,57(2):216-219.[16]马龙,侯俊德,王志刚,等.硬膜外麻醉联合全麻复合右美托咪定对腹腔镜结直肠癌根治术患者免疫功能及应激反应的影响[J].广西医科大学学报,2018,35(8):1076-1079.[17]张夏青,张玉勤,杨宗林,等.两种麻醉方式用于老年高血压患者腹腔镜全子宫切除术的对比研究[J].安徽医药,2018,22(3):490-493.[18]郭波,陈晓燕.老年妇科腹腔镜手术麻醉中静吸复合麻醉与全凭静脉麻醉的效果对比[J].中国老年学杂志,2017,37(5):1192-1194.[19]吴波,陈俊冉,梁勇.对比分析静吸复合麻醉与全凭静脉麻醉在老年腹腔镜手术患者麻醉效果及安全性[J].贵州医药,2021,45(10):1599-1600.[20]Cui RS,Kai W,Wang ZL.Sevoflurane anesthesia alters cognitive function by activating inflammation and cell death in rats[J].Experimental & Therapeutic Medicine,2018,15(5):4127-4130.

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更新日期/Last Update: 1900-01-01