摘要
目的探讨依托咪酯静脉麻醉对老年患者血浆皮质醇浓度及术后认知功能障碍的影响。方法拟行全身麻醉的老年择期腹部手术患者60例,其中男35例,女25例,年龄60～80岁,ASA分级Ⅰ～Ⅲ级。随机分为依托咪酯组(E组)和异丙酚组(P组),每组各30例。麻醉诱导为咪达唑仑0.05 mg/kg、依托咪酯脂肪乳0.3mg/kg(E组)或异丙酚1.5 mg/kg(P组)、芬太尼30μg/kg、阿曲库铵0.6 mg/kg。麻醉维持以阿曲库铵(靶浓度2.0～2.5μg/mL)泵注,另E组以依托咪酯(靶浓度1.0～1.3μg/mL)泵注,P组以异丙酚(靶浓度3～4μg/mL)泵注,术中间断静注芬太尼。维持脑电双频指数(BIS)值40～60。放射免疫法检测麻醉前5 min、插管后5 min、手术结束时、术后24 h、术后48 h血浆皮质醇浓度。用简易智能状态(MMSE)法检查患者手术前1天、术后第1、3、5、7天的认知功能,并统计分值。结果与麻醉前相比,两组手术结束时及E组术后24 h的血浆皮质醇浓度均明显降低(P<0.05)。与P组相比,E组手术结束时血浆皮质醇浓度明显降低(P<0.05),两组术后48 h皮质醇浓度均恢复正常。MMSE评分比较,两组间各时间点差异均无统计学意义(P>0.05),但两组术后第1、3天MMSE评分与术前1天比较差异有统计学意义(P<0.05)。结论依托咪酯可用于老年择期腹部手术患者全凭静脉麻醉,其抑制肾上腺皮质功能是短暂的、可逆的,并且不增加术后认知功能障碍的发生率。
[Objective] To evaluate the effect of Etomidate intravenous anesthesia on serum cortisol and postoperative cognitive dysfunction （POCD） in elderly patients. [Methods] Sixty ASA Ⅰ-Ⅲelderly patients including 35 males and 25 females were scheduled for general anesthesia undergoing elective abdominal surgery. All patients were randomly divided into Etomidate group （Group E） and Propofol group （Group P）, 30 cases in each group. Anesthesia was induced with midazolam 0.05 mg/kg, Etomidate intralipid 0.3 mg/kg （Group E） or Propofol 1.5 mg/kg （Group P）, Fentanyl 30 μg/kg and atracuIium 0.6 mg/kg. Anesthesia was maintained with target concentration infusion （TCI） atracurium 2.0-2.5 μg/mL, TCI Etomidate 1.0M.3 μg/mL in Group E or TCI Propofol 3-4 μg/mL in Group P, intermittent bolus Fentanyl. To maintain the bispectral index （BIS） values between 40 and 60. The concentrations of serum eortisol were measured by radioimmunoassay before anesthesia 5 min, after intubation 5 min, the end of surgery, postoperative 24 h and 48 h after surgery,respectively. Mine-mental state examination （MMSE） method was tested to evaluate the cognitive function of patients before surgery 1-day, postoperative 1, 3, 5, 7 day and the statistical scores were compared. [Re-suits] The cortisol c, oncentrations in Group E and Group P at the end of surgery were all significantly lower than those of before anesthesia respectively （P〈0.05）. The cortisol concentration in Group E at the postopera-tive 24 h was significantly lower than that of before anesthesia （P 〈0.05）. At the end of surgery, the cortisol concentration of Group E was significantly lower than that of Group P （P〈0.05）. The cortisol concentrations in Group E and Group P at the postoperative 48 h were all back to normal. MMSE scores were not statistically different between the two groups at each time point （P 〉0.05）, but compared with the preoperative 1 day, there were significant difference of MMSE scores in two groups at the postoperative 1, 3 day （P 〈0.05）.[ Conclusion] Etomidate has a transient and reversible inhibition on the function of the adrenal cortex in the elderly patients undergoing elective abdominal surgery. Etomidate can be used in total intravenous anesthesia in the elderly patients without increasing the incidence of POCD.
出处
《中国现代医学杂志》
CAS
CSCD
北大核心
2013年第2期78-82,共5页
China Journal of Modern Medicine
基金
江西省卫生厅科技计划课题(No:20093076)
关键词
依托咪酯
静脉麻醉
老年人
血浆皮质醇
术后认知功能障碍
Etomidate
intravenous anesthesia
elderly
serum cortisol
postoperative cognitive dysfunction
