临床误诊误治2025，Vol.38Issue(20)：51-59,9.DOI:10.3969/j.issn.1002-3429.2025.20.009
不同浓度七氟烷联合丙泊酚维持全身麻醉在老年胆囊结石患者腹腔镜胆囊切除术中的应用
Application of Sevoflurane at different concentrations combined with Propofol in maintaining general anesthesia in elderly patients undergoing laparoscopic cholecystectomy for gallbladder stones
摘要
Abstract
Objective To explore the application effect of different concentrations of Sevoflurane combined with Propofol in maintaining general anesthesia in elderly patients undergoing laparoscopic cholecystectomy(LC)for gallbladder stones.Methods A total of 196 elderly patients undergoing LC for gallbladder stones who visited the hospital from January 2021 to January 2024 were selected and divided into group A(n=98)and group B(n=98)using the random number table method.Group A was given 0.5 minimum alveolar concentration(MAC)of Sevoflurane combined with Propofol to maintain general anesthesia,while group B was given 1.0 MAC of Sevoflurane combined with Propofol to maintain general anesthesia.The anesthetic effects,adverse reactions during anesthesia recovery,hemodynamic indicators[systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR)]before anesthesia induction(T0),during endotracheal intubation(T1),during pneumoperitoneum establishment(T2),at 10 min after pneumoperitoneum establishment(T3),at 3 min after pneumoperitoneum release(T4),and at extubation(T5),stress indicators(blood glucose,cortisol)at T0,T1,T3,and T5,Ricker sedation-agitation score(SAS)at T0 and at 4,8,and 12 h after surgery,and the levels of neurotrophic factors[brain-derived neurotrophic factor(BDNF),nerve growth factor(NGF)]were compared between the two groups.The postoperative cognitive dysfunction(POCD)of the patients was evaluated by using the Mini-Mental State Examination Scale at 1 d before surgery and at 1 and 7 d after the operation.Results The recovery time of spontaneous breathing,awakening time,extubation time and verbal response time in group A were all shorter than those in group B(P<0.01).In group A,DBP,SBP and HR showed a trend of first increasing,then decreasing and increasing again at T0～T5.Among them,there were significant differences at T1 and T2 compared with those at T0(P<0.05).In group B,DBP,SBP and HR showed a trend of first increasing,then decreasing and increasing again at T0～T5,and at T3～T5 DBP,SBP and HR were all lower than those at T0(P<0.05).The DBP,SBP and HR in group A at T1～T5 were all higher than those in group B(P<0.05).The blood glucose and cortisol levels in both groups showed a trend of first decreasing and then increasing at T0,T1,T3 and T5,and the fluctuation amplitudes of blood glucose and cortisol in group B at T1,T3 and T5 were smaller than those in group A(P<0.05).The SAS scores of the two groups at T0 and at 4,8,and 12 h after the operation showed a trend of first increasing and then decreasing,and there was no significant difference in the SAS scores between the two groups at 4,8 and 12 h after the operation(P>0.05).NGF and BDNF in both groups showed a trend of first decreasing and then increasing at T0 and at 4,8,and 12 h after the operation,and the NGF and BDNF in group A were higher than those in group B at 4,8 and 12 h after the operation(P<0.05).The incidence of POCD in group A at 1 d after the operation was lower than that in group B(P<0.05).There was no significant difference in the incidence of adverse reactions during anesthesia recovery between the two groups(P>0.05).Conclusion In elderly patients undergoing LC for gallbladder stones,maintaining general anesthesia with 0.5 MAC and 1.0 MAC Sevoflurane combined with Propofol both have high safety.Among them,maintaining general anesthesia with 0.5 MAC Sevoflurane combined with Propofol has advantages in regulating the secretion of BDNF and NGF of patients,improving postoperative cognitive function,and promoting patient recovery.1.0 MAC Sevoflurane combined with Propofol to maintain general anesthesia has advantages in stabilizing patient hemodynamics and inhibiting stress responses.In clinical practice,the concentration of Sevoflurane can be flexibly selected according to surgical requirements and individual patient conditions.关键词
七氟烷/丙泊酚/全身麻醉/胆囊结石/老年人/血流动力学/皮质醇/脑源性神经营养因子/药物毒性Key words
Sevoflurane/Propofol/anesthesia/gallbladder stones/the elderly/hemodynamics/cortisol/brain-derived neurotrophic factor/drug toxicity引用本文复制引用
金成财,李朝明,苏超,辜莎莎,魏金丽,秦领..不同浓度七氟烷联合丙泊酚维持全身麻醉在老年胆囊结石患者腹腔镜胆囊切除术中的应用[J].临床误诊误治,2025,38(20):51-59,9.基金项目
2021年四川省医学(青年创新)科研课题(S21014) （青年创新）
