摘要
目的比较老年女性腹腔镜手术患者术中应用丙泊酚全凭静脉麻醉与七氟醚静吸复合麻醉的临床效果以及对术后睡眠质量的影响。方法82例行腹腔镜手术治疗的老年女性患者,按随机数字表法分为七氟醚组(给予七氟醚静吸复合麻醉,41例)、丙泊酚组(给予丙泊酚全凭静脉麻醉,41例)。比较两组匹兹堡睡眠质量指数(PSQI)总分与简易智力状态检查量表(MMSE)总分、血清学指标、不良反应发生情况。结果丙泊酚组术前和术后第1、3、5天PSQI总分分别为(10.35±2.55)、(13.08±1.61)、(11.85±1.04)、(10.07±1.21)分,MMSE总分分别为(28.17±1.15)、(25.12±1.08)、(27.09±1.51)、(28.11±1.06)分;七氟醚组术前和术后第1、3、5天PSQI总分分别为(10.32±2.49)、(15.12±1.59)、(14.63±1.11)、(11.44±1.18)分,MMSE总分分别为(28.18±1.04)、(23.49±1.17)、(25.52±1.44)、(27.09±1.05)分;术前两组PSQI总分、MMSE总分比较未见差异(P>0.05);术后第1天、第3天,两组PSQI总分较术前升高、MMSE总分较术前降低,但丙泊酚组PSQI总分比七氟醚组低、MMSE总分比七氟醚组高(P<0.05);术后第5天,七氟醚组PSQI总分较术前升高、MMSE总分较术前降低,但丙泊酚组PSQI总分比七氟醚组低、MMSE总分比七氟醚组高(P<0.05);丙泊酚组术后第5天PSQI总分、MMSE总分与术前比较未见差异(P>0.05)。术前和术后第1、3、5天,丙泊酚组血清褪黑素分别为(38.35±2.63)、(33.63±1.85)、(35.75±1.58)、(37.37±1.43)pg/ml,血清白介素-6分别为(66.75±4.41)、(94.32±9.95)、(77.63±6.03)、(70.22±5.05)pg/ml,血清皮质醇分别为(195.65±18.88)、(223.65±9.47)、(216.60±5.11)、(205.05±8.05)nmol/L;七氟醚组血清褪黑素分别为(38.32±2.61)、(30.45±1.99)、(33.03±1.55)、(36.74±1.25)pg/ml,血清白介素-6分别为(66.71±4.39)、(116.08±15.63)、(90.12±7.78)、(82.48±6.62)pg/ml,血清皮质醇分别为(195.66±18.75)、(241.84±9.55)、(228.56±5.08)、(211.13±7.01)nmol/L;术前两组血清褪黑素、白介素-6、皮质醇学水平比较未见差异(P>0.05);术后第1天、第3天、第5天,两组血清褪黑素水平较术前降低,血清白介素-6、皮质醇水平较术前升高,但丙泊酚组血清褪黑素水平高于七氟醚组,血清白介素-6、皮质醇水平低于七氟醚组(P<0.05)。丙泊酚组患者术后不良反应发生率(17.07%)与七氟醚组(19.51%)比较未见差异(P>0.05)。结论对于择期进行腹腔镜手术治疗的老年女性患者术中辅以丙泊酚全凭静脉麻醉,能进一步减轻对术后睡眠质量造成的负面影响,同时可减轻炎症应激反应,调节褪黑素水平,促进认知功能恢复,且不会发生严重不良反应,安全性高。
Objective To compare the clinical effect of propofol total intravenous anesthesia and sevoflurane combined anesthesia during surgery in elderly female patients undergoing laparoscopic surgery,as well as their impact on postoperative sleep quality.Methods 82 elderly female patients who underwent laparoscopic surgery were assigned to the sevoflurane group(given sevoflurane combined anesthesia,41 cases)and the propofol group(given propofol total intravenous anesthesia,41 cases)using a random number table.The Pittsburgh Sleep Quality Index(PSQI)total score,Mini Mental State Examination(MMSE)total score,serum melatonin levels,serological indicators,and occurrence of adverse reactions were compared between the two groups.Results In propofol group,the PSQI total scores before surgery and on postoperative days 1,3,and 5 were(10.35±2.55),(13.08±1.61),(11.85±1.04),and(10.07±1.21)points,and the MMSE total scores were(28.17±1.15),(25.12±1.08),(27.09±1.51)and(28.11±1.06)points;in sevoflurane group,the PSQI total score before surgery and on postoperative days 1,3,and 5 were(10.32±2.49),(15.12±1.59),(14.63±1.11)and(11.44±1.18)points,and the MMSE total scores were(28.18±1.04),(23.49±1.17),(25.52±1.44)and(27.09±1.05)points.There was no significant difference in the total scores of PSQI and MMSE between the two groups before surgery(P>0.05).On postoperative days 1 and 3,the PSQI total score was higher and the MMSE total score was lower in both groups compared with before surgery;but propofol group had lower PSQI total score and higher MMSE total score than those in sevoflurane group(P<0.05).On postoperative day 5,the PSQI total score in sevoflurane group was higher and the MMSE total score was lower in both groups compared with before surgery;but propofol group had lower PSQI total score and higher MMSE total score than those in sevoflurane group(P<0.05).The total score of PSQI and MMSE in propofol group on postoperative day 5 were not significantly different from those before surgery(P>0.05).In propofol group,the serum melatonin before surgery and on postoperative days 1,3,and 5 were(38.35±2.63),(33.63±1.85),(35.75±1.58)and(37.37±1.43)pg/ml,the serum interleukin-6 were(66.75±4.41),(94.32±9.95),(77.63±6.03)and(70.22±5.05)pg/ml,and the serum cortisol were(195.65±18.88),(223.65±9.47),(216.60±5.11)and(205.05±8.05)nmol/L;in sevoflurane group,the serum melatonin before surgery and on postoperative days 1,3,and 5 were(38.32±2.61),(30.45±1.99),(33.03±1.55)and(36.74±1.25)pg/ml,the serum interleukin-6 were(66.71±4.39),(116.08±15.63),(90.12±7.78)and(82.48±6.62)pg/ml,the serum cortisol were(195.66±18.75),(241.84±9.55),(228.56±5.08)and(211.13±7.01)nmol/L.There were no differences in serum levels of melatonin,interleukin-6 and cortisol between the two groups before surgery(P>0.05).On postoperative days 1,3 and 5,the levels of serum melatonin were decreased,and the levels of serum interleukin-6 and cortisol were increased in both groups compared with before surgery;but the serum melatonin levels in propofol group was higher than those in sevoflurane group,and the serum interleukin-6 and cortisol levels were lower than those in sevoflurane group(P<0.05).There was no difference in the incidence of postoperative adverse reactions between propofol group(17.07%)and sevoflurane group(19.51%)(P>0.05).Conclusion For elderly female patients undergoing elective laparoscopic surgery,intraoperative propofol assisted total intravenous anesthesia can further reduce the negative impact on postoperative sleep quality,alleviate inflammatory stress response,regulate melatonin levels,promote the recovery of cognitive function with no serious adverse reactions,and has high safety.
作者
钟珍玉
ZHONG Zhen-yu(Longyan Boai Hospital,Longyan 364000,China)
出处
《中国现代药物应用》
2025年第4期118-121,共4页
Chinese Journal of Modern Drug Application
关键词
丙泊酚全凭静脉麻醉
七氟醚静吸复合麻醉
腹腔镜手术
老年
女性
睡眠质量
Propofol total intravenous anesthesia
Sevoflurane combined anesthesia
Laparoscopic surgery
Old age
Female
Sleep quality
