文章摘要
田 昀,王 宇,谭 杰,罗 卿,高志勇.不同麻醉方法对腹腔镜子宫全切2型糖尿病患者应激反应、苏醒质量及认知功能的影响[J].,2021,(8):1584-1588
不同麻醉方法对腹腔镜子宫全切2型糖尿病患者应激反应、苏醒质量及认知功能的影响
Influence of Different Anesthesia Methods on Stress Response, Waking Quality and Cognitive Function in Patients with Type 2 Diabetes Mellitus Undergoing Laparoscopic Hysterectomy
投稿时间:2020-08-26  修订日期:2020-09-20
DOI:10.13241/j.cnki.pmb.2021.08.041
中文关键词: 2型糖尿病  静吸复合麻醉  应激反应  苏醒质量  认知功能
英文关键词: Type 2 diabetes mellitus  Intravenous inhalational anesthesia  Stress response  Waking quality  Cognitive function
基金项目:四川省卫生和计划生育委员会科研项目(18PJ182)
作者单位E-mail
田 昀 航空工业三六三医院/西南医科大学附属成都三六三医院麻醉科 四川 成都 610041 tt19850901323@163.com 
王 宇 航空工业三六三医院/西南医科大学附属成都三六三医院麻醉科 四川 成都 610041  
谭 杰 航空工业三六三医院/西南医科大学附属成都三六三医院麻醉科 四川 成都 610041  
罗 卿 航空工业三六三医院/西南医科大学附属成都三六三医院麻醉科 四川 成都 610041  
高志勇 航空工业三六三医院/西南医科大学附属成都三六三医院麻醉科 四川 成都 610041  
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中文摘要:
      摘要 目的:探讨不同麻醉方法对腹腔镜子宫全切2型糖尿病患者应激反应、苏醒质量及认知功能的影响。方法:选取2018年5月-2019年5月在本院接受腹腔镜子宫全切术治疗的2型糖尿病患者60例作为研究对象,采用随机数字表法将入组患者分为全凭静脉麻醉组、静吸复合麻醉组,每组各30例。全凭静脉麻醉组患者接受靶控输注丙泊酚、瑞芬太尼麻醉,静吸复合麻醉组患者接受靶控输注丙泊酚、瑞芬太尼复合七氟烷吸入麻醉。对比两组患者的围术期血流动力学指标[心率(HR)、平均动脉压(MAP)]、应激激素[皮质醇(Cor)、去甲肾上腺素(NE)、血管紧张素Ⅰ(AngⅠ)、空腹血糖(FPG)]水平,术后苏醒质量及认知功能差异。记录并比较两组患者术后麻醉相关并发症的发生情况。结果:切皮时(T2)、缝合时(T3)、术后6 h(T4)时,静吸复合麻醉组患者的HR、MAP低于全凭静脉麻醉组患者,血清中Cor、NE、AngⅠ、FPG的水平低于全凭静脉麻醉组患者(P<0.05)。拔管后5 min、术后6 h,静吸复合麻醉组患者的Steward苏醒评分总分及各个子项目评分均高于全凭静脉麻醉组患者(P<0.05)。拔管后5 min,静吸复合麻醉组患者的简易智能量表(MMSE)评分高于全凭静脉麻醉组(P<0.05)。两组患者术后麻醉相关并发症的发生情况比较差异无统计学意义(P>0.05)。结论:静吸复合麻醉可有效减轻腹腔镜子宫全切2型糖尿病患者的围术期应激反应,且在提升苏醒质量、改善拔管后早期认知功能方面具有积极作用。
英文摘要:
      ABSTRACT Objective: To investigate the effects of different anesthesia methods on stress response, waking quality and cognitive function in patients with type 2 diabetes mellitus undergoing laparoscopic hysterectomy. Methods: 60 cases of type 2 diabetes patients underwent laparoscopic hysterectomy in our hospital during May 2018 to May 2019 were chosen as research subject, they were randomly divided into intravenous anesthesia group and intravenous inhalational anesthesia group, 30 patients in each group. Patients in intravenous anesthesia group received target-controlled infusion of propofol and remifentanil, while those in intravenous inhalational anesthesia group received target-controlled infusion of propofol and remifentanil combined with sevoflurane under inhalation anesthesia. The perioperative hemodynamic indexes [heart rate (HR), mean arterial pressure (MAP)], stress hormones [cortisol (Cor), norepinephrine (NE), angiotensin Ⅰ (Ang Ⅰ), fasting plasma glucose (FPG)] levels, postoperative waking quality and cognitive function were compared between the two groups. The occurrence of postoperative anesthesia related complications were recorded and compared between the two groups. Results: It was found that HR and MAP levels of intravenous inhalational anesthesia group were lower than those of intravenous anesthesia group, the levels of serum Cor, NE, AngⅠ, FPG were lower than those of intravenous anesthesia group (P<0.05) at the time of skin cutting (T2), suturing (T3), and 6h after operation (T4). 5 minutes after extubation, 6 hours after operation, total score of Steward resuscitation and the score of each subitem in intravenous inhalational anesthesia group were higher than those in intravenous anesthesia group (P<0.05). 5 minutes after extubation, simple intelligent scale (MMSE) scores of intravenous inhalational anesthesia group were higher than that in intravenous anesthesia group (P<0.05). There were no statistically significant difference in postoperative anaesthesia-related adverse reactions between the two groups (P>0.05). Conclusion: Intravenous inhalational anesthes can effectively reduce the perioperative stress response of patients with type 2 diabetes mellitus undergoing laparoscopic hysterectomy, and has a positive role in improving the quality of recovery and early cognitive function after extubation.
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