丙泊酚联合艾司氯胺酮麻醉诱导对老年外科手术患者围手术期应激、炎症反应及术后认知功能的影响
Influence of anesthetic induction of propofol combined with esketamine on perioperative stress and inflammatory responses and postoperative cognition of elderly surgical patients.
作者信息
Tu Wencai, Yuan Haibo, Zhang Shaojin, Lu Fang, Yin Lin, Chen Chuanfeng, Li Jianhua
机构信息
Department of Anesthesiology, Yichun People's Hospital Yichun 336000, Jiangxi Province, China.
出版信息
Am J Transl Res. 2021 Mar 15;13(3):1701-1709. eCollection 2021.
OBJECTIVE
To analyze the influence of anesthetic induction of propofol combined with esketamine on perioperative stress and inflammatory responses and postoperative cognition in elderly surgical patients.
METHODS
A total of 80 elderly surgical patients were randomly divided into a control group (n=40) and a study group (n=40). The control group received anesthetic induction with propofol combined with sufentanil, while the study group received anesthetic induction with propofol combined with esketamine. Hemodynamics, stress and inflammatory responses and changes in cognitive function, perioperative related indexes and adverse responses were compared between the two groups.
RESULTS
At T, the levels of adrenaline, norepinephrine, endothelin, C-reactive protein, white blood cell and procalcitonin in the two groups were not markedly changed compared with those at T. The levels of the indices at T and T were elevated compared with those at T. However, the levels of the indices at T were almost close to those at T, and the levels in the study group were higher than those in the control group. There were statistically significant differences in the comparison of the interaction of the levels of the aforementioned indices between groups, between time points, and between groups and time points ( < 0.05). At 24 h after surgery, the Montreal Cognitive Assessment (MoCA) scores were decreased in both groups, and the MoCA scores in the study group were higher than those in the control group ( < 0.05). The anesthesia time and consciousness recovery time in the study group were shorter than those in the control group ( < 0.05).
CONCLUSION
The anesthetic induction of propofol combined with esketamine, exhibits a good safety profile and reliability, it can improve hemodynamics and surgical stress and inflammatory responses, shorten anesthesia time, promote the recovery of postoperative cognitive function, and cause relatively mild adverse responses.
目的
分析丙泊酚联合艾司氯胺酮麻醉诱导对老年手术患者围手术期应激、炎症反应及术后认知功能的影响。
方法
将80例老年手术患者随机分为对照组（n = 40）和研究组（n = 40）。对照组采用丙泊酚联合舒芬太尼进行麻醉诱导，研究组采用丙泊酚联合艾司氯胺酮进行麻醉诱导。比较两组患者的血流动力学、应激和炎症反应以及认知功能变化、围手术期相关指标和不良反应。
结果
在T₁时，两组肾上腺素、去甲肾上腺素、内皮素、C反应蛋白、白细胞和降钙素原水平与T₀时相比无明显变化。T₂和T₃时各项指标水平较T₀时升高。然而，T₃时各项指标水平几乎接近T₀时，且研究组水平高于对照组。上述指标水平在组间、时间点间以及组与时间点交互比较上差异有统计学意义（P < 0.05）。术后24 h，两组蒙特利尔认知评估（MoCA）评分均降低，且研究组MoCA评分高于对照组（P < 0.05）。研究组麻醉时间和意识恢复时间短于对照组（P < 0.05）。
结论
丙泊酚联合艾司氯胺酮麻醉诱导具有良好的安全性和可靠性，可改善血流动力学及手术应激和炎症反应，缩短麻醉时间，促进术后认知功能恢复，且不良反应相对较轻。
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