摘要
目的比较静脉-吸入复合麻醉(静吸复合麻醉)与全凭静脉麻醉在腹腔镜脾切除术中的应用效果。方法选择2016年1月至2017年9月于陆军军医大学第二附属医院接受腹腔镜脾切除术的116例患者为研究对象,采用随机数字表法将其分为全凭静脉组(58例)和静吸复合组(58例),比较两组患者的麻醉效果、不良反应发生情况、收缩压、舒张压、心率、去甲肾上腺素和肾上腺素水平、简易精神状态检查(mini-mental state examination,MMSE)量表评分。结果两组患者麻醉起效时间和手术时间比较差异均无统计学意义(均P>0.05)。全凭静脉组患者拔管时间和苏醒时间均显著短于静吸复合组(均P<0.05),低血压和躁动发生率均显著低于静吸复合组(均P<0.05),两组患者恶心呕吐发生率比较差异无统计学意义(P>0.05)。麻醉诱导前和手术结束时,两组患者收缩压、舒张压和心率比较差异均无统计学意义(均P>0.05);气管插管时和气腹后5 min,全凭静脉组患者收缩压、舒张压和心率均显著低于同期静吸复合组(均P<0.05)。麻醉诱导前,两组患者去甲肾上腺素和肾上腺素水平比较差异均无统计学意义(均P>0.05);气管插管时、气腹后5 min和手术结束时,全凭静脉组患者去甲肾上腺素和肾上腺素水平均显著低于同期静吸复合组(均P<0.05)。麻醉后6 h、12 h、24 h,全凭静脉组患者MMSE评分均显著高于同期静吸复合组(均P<0.05)。麻醉诱导前和麻醉后72 h,两组患者MMSE评分比较差异均无统计学意义(均P>0.05)。麻醉后6 h和12 h,全凭静脉组患者术后认知功能障碍发生率均显著低于同期静吸复合组(均P<0.05)。结论与静吸复合麻醉相比,全凭静脉麻醉可使腹腔镜脾切除术患者的血压和心率更稳定,对患者术后认知功能的影响更小,安全性更高,临床效果更佳。
Objective To compare the effect of combined intravenous and inhalation anesthesia and total intravenous anesthesia in laparoscopic splenectomy.Method A total of 116 patients underwent laparoscopic splenectomy in the Second Affiliated Hospital of Army Medical University from January 2016 to September 2017 were selected as the study subjects.According to the random number table method,they were divided into total intravenous group(n=58)and combined intravenous and inhalation group(n=58).The anesthetic effects,adverse reactions,systolic pressure,diastolic pressure,heart rates,levels of noradrenaline and adrenaline,minimental state examination(MMSE)scale scores were compared between the two groups.Result There were no significant differences in anesthesia onset time and operation time between the two groups(all P>0.05).The extubation time and awakening time in total intravenous group were significantly shorter than those in combined intravenous and inhalation group(all P<0.05),the incidence of hypotension and restlessness were significantly lower than those in combined intravenous and inhalation group(all P<0.05).There was no significant difference in the incidence of nausea and vomiting between the two groups(P>0.05).There were no significant differences in systolic pressure,diastolic pressure and heart rate between the two groups before anesthesia induction and at the end of operation(all P>0.05),at the time of endotracheal intubation and 5 min after pneumoperitoneum,the systolic pressure,diastolic pressure and heart rate in total intravenous group were significantly lower than those in combined intravenous and inhalation group at the same time(all P<0.05).Before anesthesia induction,there were no significant differences in norepinephrine and epinephrine levels between the two groups(all P>0.05),during tracheal intubation,5 min after pneumoperitoneum and at the end of operation,the norepinephrine and epinephrine levels in total intravenous group were significantly lower than those in combined intravenous and inhalation group at the same time(all P<0.05).At 6 h,12 h and 24 h after anesthesia,the MMSE scores in total intravenous group were significantly higher than those in combined intravenous and inhalation group at the same time(all P<0.05).Before anesthesia induction and 72 h after anesthesia,there were no significant differences in MMSE scores between the two groups(all P>0.05).At 6 h and 12 h after anesthesia,the incidence of postoperative cognitive dysfunction in total intravenous group were significantly lower than those in com bined intravenous and inhalation group at the same time(all P<0.05).Conclusion Compared with combined intravenous and inhalation anesthesia,total intravenous anesthesia can make blood pressure and heart rate more stable in patients undergoing laparoscopic splene ctomy,the influence on postoperative cognitive function is smaller,the safety is higher,and the clinical effect is better.
作者
栗村瑞
丁锦屏
Li Cunrui;Ding Jinping(Department of Anesthesiology,the Second Affiliated Hospital of Army Medical University,Chongqing 400037,China)
出处
《中国医学前沿杂志（电子版）》
2020年第7期57-61,共5页
Chinese Journal of the Frontiers of Medical Science(Electronic Version)
基金
重庆市科学技术委员会项目(cstc2018jscx-msy0043)。
关键词
静脉-吸入复合麻醉
全凭静脉麻醉
腹腔镜脾切除术
Combined intravenous and inhalation anesthesia
Total intravenous anesthesia
Laparoscopic splenectomy
