摘要
目的观察磷酸肌酸钠对老年患者全凭静脉麻醉心功能保护和术后认知功能障碍的影响。方法选择2016年1月至2018年6月行腹腔镜胆囊切除术的老年患者130例,根据随机数字方法将患者分为观察组和对照组,每组65例。对照组予以常规全凭静脉麻醉,观察组在对照组的基础上予以磷酸肌酸钠治疗。观察麻醉前(T0)、手术结束前30min(T1)、拔管时(T2)和拔管后10min(T3)各个时点心率,血压和血流动力学水平的变化,2组的手术时间、拔管时间、Steward评分、清醒时间和意识恢复时间比较,麻醉前后基质金属蛋白酶-9(MMP-9)、脂联素(ADP)、简易智力状态量表(MMSE)和韦氏记忆量表(WMS)评分变化。结果对照组T1和T2时间点的心率、收缩压、舒张压和平均动脉压水平较T0时间点和观察组明显升高(P<0.01)。观察组T1时间点的心指数和每博量指数较T0时间点和对照组明显升高(P<0.01),位T1体循环阻力指数和肺循环阻力指数较对照组明显降低(P<0.01),而肺毛细血管嵌压和中心静脉压2组在各个时间点比较差异无统计学意义(P>0.05)。观察组的拔管时间、Steward评分、清醒时间和意识恢复时间明显短于或者低于对照组(P<0.01),而2组手术时间差异无统计学意义(P>0.05)。2组麻醉前MMP-9、ADP、MMSE和WMS评分水平差异无统计学意义(P>0.05),麻醉后2组MMP-9水平较麻醉前明显升高(P<0.01),而ADPMMSE和WMS评分水平较麻醉前明显降低(P<0.01),观察组的升高或者降低幅度较对照组明显降低(P<0.01)。结论磷酸肌酸钠对全凭静脉麻醉的老年患者具有明显改善血液动力学和缓解术后认知功能障碍,能够明显提高手术患者术后苏醒质量,缩短苏醒时间,促进术后意识恢复时间。
Objective To investigate the effects of creatine phosphate sodium on cardiac function and postoperative cognitive dysfunction in elderly patients undergoing total intravenous anesthesia.Methods A total of 130 elderly patients who underwent laparoscopic cholecystectomy from January 2016 to June 2018 were divided into observation group(n=65)and control group(n=65)according to random number methord.The patients in control group were treated by routine total intravenous anesthesia,however,the patients in observation group,on the basis of control group,were treated by creatine phosphate sodium.The changes of heart rate,blood pressure and hemodynamics levels were observed and compared between the two groups at different time points including pre-anesthesia(T0),30 min before the end of operation(T1),extubation time(T2)and 10 min after extubation(T3).Moreover the operation duration,the extubation time,Steward score,awake time,and recovery time of consciousness were also observed and compared between the two groups.In addition the levels of matrix metalloproteinase(MMP-9),adiponectin(ADP),and the changes of mini-mental state examination(MMSE)and Wechsler memory scale(WMS)scores before and after anesthesia were observed and compared between the two groups.Results The levels of heart rate,systolic pressure,diastolic pressure and mean arterial pressure at T1 and T2 in control group were significantly higher than those at T0,moreover,the cardiac index at T1 and heart beat index at T2 in control group were significantly higher than those at T0,however,the cardiac index at T1 and heart beat index at T2 in observation group were significantly higher than those in control group(P<0.01),and the systemic circulation resistance index and pulmonary circulation resistance index at T1 in observation group were significantly lower than those in control group(P<0.01).However there were no significant differences in pulmonary capillary wedge pressure and central venous pressure between the two groups at different time points(P>0.05).The extubation time,Steward score,awake time and consciousness recovery time in observation group were significantly shorter or lower than those in control group(P<0.01),howerve there was no significant difference in operation time between the two groups(P>0.05).Moreover there were no significant differences in MMP-9,ADP,MMSE and WMS scores between the two groups before anesthesia(P>0.05).After anesthesia the MMP-9 levels in both groups were significantly higher than those before anesthesia(P<0.01),however the levels of ADP,MMSE and WMS scores were significantly lower than those before anesthesia(P<0.01).In addition,the increasing degree or decreasing degree in observation group was significantly lower than that in control group(P<0.01).Conclusion The creatine phosphate sodium can significantly improve hemodynamics and relieve postoperative cognitive dysfunction in elderly patients undergoing total intravenous anesthesia,which can significantly improve the quality of postoperative palinesthesia,shorten the awakening time and promote postoperative consciousness recovery time.
作者
朱海峰
ZHU Haifeng(The Eighth People’s Hoapital,Shanghai 200235,China)
出处
《河北医药》
CAS
2019年第15期2280-2283,2287,共5页
Hebei Medical Journal
关键词
磷酸肌酸钠
全凭静脉麻醉
心功能
认知功能障碍
金属蛋白酶
sodium creatine phosphate
total intravenous anesthesia
cardiac function
cognitive dysfunction
metalloproteinase
