[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.[doi:DOI:10.3969/j.issn.1000-7377.2022.10.014]
　CHEN Xueying,CHEN Quan.Effect of laparoscopic abdominal surgery under general anesthesia on hemodynamics,sedative effect and cognitive function in elderly patients[J].,2022,51(10):1235-1239.[doi:DOI:10.3969/j.issn.1000-7377.2022.10.014]
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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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《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
51
期数:
2022年10期
页码:
1235-1239
栏目:
临床研究
出版日期:
2022-10-05

文章信息/Info

Title:
Effect of laparoscopic abdominal surgery under general anesthesia on hemodynamics,sedative effect and cognitive function in elderly patients
作者:
陈雪迎; 陈 权
(锦州医科大学附属第一医院,辽宁 锦州 121001)
Author(s):
CHEN Xueying; CHEN Quan
(The First Affiliated Hospital of Jinzhou Medical University,Jinzhou 121001,China)
关键词:
腹部手术;  老年人;  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;  General anesthesia;  Laparoscopic surgery;  Hemodynamics;  Sedative effect;  Cognitive function
分类号:
R 656
DOI:
DOI:10.3969/j.issn.1000-7377.2022.10.014
文献标志码:
A
摘要:
目的:探讨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影响。方法:选择全麻腹腔镜手术的老年患者62例,依据其年龄不同分为60～75岁组(n=32)和>75岁组(n=30),另选行全麻腹腔镜手术的<60岁患者40例作为对照组。记录各组入室时(T1)、全麻诱导插管后(T2)、建立气腹后60 min(T3)以及苏醒后(T4)的血流动力学[平均动脉压(MAP)、动脉血二氧化碳分压(PaCO2)、动脉血氧分压(PaO2)、心率(HR)]以及呼吸恢复时间、苏醒时间、拔管时间,于苏醒后30 min行Ramsay评分,测定术前及术后6、24 h肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)水平,并于术前及术后1、3 d行蒙特利尔认知评估量表(MoCA)评分。结果:三组MAP T1时刻与T2、T3、T4时刻比较差异有统计学意义(均P<0.05); T2～T4时刻,60～75岁组和对照组MAP、PaO2、HR显著高于>75岁组,PaCO2显著低于>75岁组,差异有统计学意义(均P<0.05); 60～75岁组和对照组呼吸恢复时间、苏醒时间及拔管时间均较>75岁组明显缩短(均P<0.05),三组Ramsay评分比较无统计学差异(均P>0.05); 术后6、24 h,>75岁组血清TNF-α、IL-6水平明显高于60～75岁组和对照组(均P<0.05); >75岁组术后1、3 d的MoCA评分明显低于60～75岁组和对照组,差异有统计学意义(均P<0.05)。结论:全麻腹腔镜手术对60～75岁老年腹部手术患者术中血流动力学、炎症因子指标的影响较轻微,可满足患者对松肌的要求,促进术后麻醉苏醒,并能降低术后认知功能障碍发生的可能。
Abstract:
Objective:To investigate the effect of laparoscopic abdominal surgery under general anesthesia on hemodynamics,sedative effect and cognitive function in elderly patients.Methods:A total of 62 elderly patients underwent laparoscopic abdominal surgery under general anesthesia were selected and divided into 60 to 75 years old group(32 cases)and >75 years old group(30 cases)according to age.Another 40 patients <60 years old underwent laparoscopic surgery under general anesthesia during the same period were selected as control group.The hemodynamic indicators(MAP,PaCO2,PaO2 and HR)at the time of entering the room(T1),after intubation(T2),at 60 minutes after the establishment of pneumoperitoneum(T3)and after wake-up(T4),as well as respiration recovery time,wake-up time and extubation time were recorded.Ramsay score was performed at 30 minutes after wake-up.The levels of TNF-α and IL-6 were measured before surgery and at 6,24 hours after surgery.MoCA scores were performed before and on 1,3 days after surgery.Results:MAP of three groups at T1 was similar to that at T2,T3 and T4(all P<0.05).At T2 to T4,MAP,PaO2 and HR of the 60 to 75 years old group and the control group were significantly higher than those of the >75 years old group,and PaCO2 was significantly lower than that of the >75 years old group(all P<0.05).The respiration recovery time,wake-up time and extubation time of the 60 to 75 years old group and the control group were significantly shorter than those of the >75 years old group(all P<0.05).The three groups had similar Ramsay scores(all P>0.05).At 6,24 hours after surgery,serum TNF-α and IL-6 levels in the >75 years old group were significantly higher than those in the 60 to 75 years old group and the control group(all P<0.05).The MoCA scores of the >75 years old group on 1,3 days after surgery were significantly lower than those of the 60 to 75 years old group and the control group(all P<0.05).Conclusion:Laparoscopic abdominal surgery under general anesthesia has little influence on hemodynamics and inflammatory factors in elderly patients aged 60 to 75,which can meet the requirements of patients for muscle relaxation,promote postoperative recovery from anesthesia,and reduce the risk of postoperative cognitive dysfunction.

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备注/Memo

备注/Memo:
基金项目:辽宁省教育厅科学技术研究项目(JYTJCZR2020050)
更新日期/Last Update: 2022-10-07