摘要
目的探究地氟烷与七氟烷吸入麻醉对下肢骨科手术老年患者的影响。方法选取2022年1月至2024年1月在眉山市人民医院于全身麻醉下择期实施下肢骨科手术的65岁以上患者102例,经简单化随机分组(随机数字表法)均分为地氟烷组(n=51)和七氟烷组(n=51)。地氟烷组术中维持吸入4.5%~5.5%地氟烷,七氟烷组吸入1.5%~2.0%七氟烷。统计两组患者的麻醉起效时间和达到麻醉深度时间。观察两组患者入手术室时(T_(0))、拔管后1 min(T_(1))、拔管后10 min(T_(2))和拔管后1 h(T_(3))的血流动力学与Ramsay镇静评分以及术后苏醒质量及不良反应发生率,比较两组患者不同时间(术前、术后1、24、48 h)简易精神状态检查量表(mini-mental state examination,MMSE)评分。结果地氟烷组麻醉起效时间、达到麻醉深度时间[分别为(2.18±0.26)min、(8.59±2.06)min]均短于七氟烷组[分别为(3.92±1.42)min、(9.55±2.75)min](t=8.608、1.995,均P<0.05)。T_(1)、T_(2)、T_(3)时七氟烷组的心率[分别为(85.67±1.52)次/min、(84.23±1.74)次/min、(79.63±1.75)次/min]高于地氟烷组[分别为(83.10±2.05)次/min、(82.11±1.63)次/min、(76.55±1.47)次/min](t=7.192、6.350、9.624,均P<0.05)。T_(1)时地氟烷组脉搏血氧饱和度[(93.45±1.96)%]低于七氟烷组[(95.73±1.81)%](t=6.103,P<0.05)。T_(2)、T_(3)时地氟烷组Ramsay镇静评分[分别为(3.27±1.23)分、(2.35±0.11)分]低于七氟烷组[分别为(3.95±1.22)分、(2.52±0.20)分](t=2.803、5.319,均P<0.05)。地氟烷组术后自主呼吸恢复时间、唤醒睁眼时间、定向力恢复时间、拔管时间[分别为(6.21±1.52)min、(13.27±2.10)min、(18.56±1.23)min、(15.72±2.01)min]均短于七氟烷组[分别为(7.56±1.23)min、(15.89±2.11)min、(22.17±2.16)min、(16.75±2.30)min](t=4.931、6.285、10.372、2.408,均P<0.05)。术后1、24 h地氟烷组患者MMSE评分[分别为(25.51±1.24)分、(28.67±0.47)分]高于七氟烷组[分别为(22.17±1.35)分、(28.25±0.81)分](t=13.012、3.203,均P<0.05)。地氟烷组与七氟烷组患者术后1 h内不良反应发生率(分别为9.80%、11.76%)比较,差异无统计学意义(χ^(2)=0.102,P>0.05)。结论在老年患者下肢骨科手术中,地氟烷吸入麻醉效果较七氟烷更为理想,麻醉起效较快,且苏醒期生命体征更平稳,能有效避免短期认知功能障碍,安全性良好。
Objective To explore the effect of desflurane and sevoflurane inhalation anesthesia on elderly patients undergoing lower extremity orthopedic surgery.Methods A total of 102 patients aged over 65 who were scheduled for lower extremity orthopedic surgery under general anesthesia in the Meishan People’s Hospital from January 2022 to January 2024 were selected and divided into the desflurane group(n=51)and the sevoflurane group(n=51)by the random number table method.During the surgery,the desflurane group continuously inhaled 4.5%-5.5%desflurane and the sevoflurane group inhaled 1.5%-2.0%sevoflurane.The onset time of anesthesia and the time to reach anesthesia depth were counted between the two groups.The hemodynamics and Ramsay sedation scores of both groups were observed at the time of entering the operating room(T_(0)),1 min after extubation(T_(1)),10 min after extubation(T_(2))and 1 h after extubation(T_(3)).The postoperative recovery quality and the incidence rates of adverse reactions were compared.The Mini-Mental State Examination(MMSE)scores were compared before the surgery and at 1,24 and 48 h after the surgery.Results The onset time of anesthesia and the time to reach anesthesia depth in the desflurane group were(2.18±0.26)min and(8.59±2.06)min,shorter than(3.92±1.42)min and(9.55±2.75)min in the sevoflurane group(t=8.608,1.995,both P<0.05).The heart rate values in the sevoflurane group at T_(1),T_(2) and T_(3) were(85.67±1.52)beats/min,(84.23±1.74)beats/min and(79.63±1.75)beats/min,higher than(83.10±2.05)beats/min,(82.11±1.63)beats/min and(76.55±1.47)beats/min in the desflurane group(t=7.192,6.350,9.624,all P<0.05).The pulse oxygen saturation was(93.45±1.96)%in the desflurane group,lower than(95.73±1.81)%in the sevoflurane group at T_(1)(t=6.103,P<0.05).The Ramsay sedation scores at T_(2) and T_(3) in the desflurane group were(3.27±1.23)points and(2.35±0.11)points,lower than(3.95±1.22)points and(2.52±0.20)points in the sevoflurane group(t=2.803,5.319,both P<0.05).The postoperative spontaneous breathing recovery time,wake-up eye opening time,orientation recovery time and extubation time in the desflurane group were(6.21±1.52)min,(13.27±2.10)min,(18.56±1.23)min and(15.72±2.01)min,significantly shorter than(7.56±1.23)min,(15.89±2.11)min,(22.17±2.16)min and(16.75±2.30)min in the sevoflurane group(t=4.931,6.285,10.372,2.408,all P<0.05).The MMSE scores at 1 and 24 h after the surgery in the desflurane group were(25.51±1.24)points and(28.67±0.47)points,higher than(22.17±1.35)points and(28.25±0.81)points in the sevoflurane group(t=13.012,3.203,both P<0.05).There was no statistically significant difference in the incidence of adverse reactions within 1 h after the surgery between the desflurane group and the sevoflurane group(9.80%vs 11.76%)(χ^(2)=0.102,P>0.05).Conclusion For elderly patients undergoing lower extremity orthopedic surgery,the effect of desflurane inhalation anesthesia is better than that of sevoflurane inhalation anesthesia,with faster anesthesia onset and more stable vital signs during recovery.It can effectively avoid short-term cognitive dysfunction and demonstrate good safety.
作者
刘军武
陈婷婷
贺红侠
周磊
刘仲军
张顺
黄菲
LIU Junwu;CHEN Tingting;HE Hongxia;ZHOU Lei;LIU Zhongjun;ZHANG Shun;HUANG Fei(Department of Anaesthesiology,Meishan People’s Hospital,Meishan 620010,China)
出处
《中国药物应用与监测》
2025年第7期1283-1287,共5页
Chinese Journal of Drug Application and Monitoring
基金
四川省国际医学交流促进会科研课题(L20230410008)。
关键词
地氟烷
七氟烷
下肢骨科手术
苏醒质量
认知功能
desflurane
sevoflurane
lower extremity orthopedic surgery
recovery quality
cognitive function
