不同麻醉方法应用于经肛门内镜显微手术对老年患者认知功能和麻醉质量的影响

Effect of different anesthetic methods on cognitive function and anesthetic quality of elderly patients underwent transanal endoscopic microsurgery

摘要:

目的 探讨不同麻醉方法应用于经肛门内镜显微手术（TEM）对老年患者认识功能和麻醉质量的影响。方法 选取2018年1月—2019年6月该院行TEM手术的老年患者68例，采用随机数字表法将患者分为对照组（n = 34）和观察组（n = 34）。对照组行常规全身麻醉，观察组行右美托咪定复合全身麻醉。比较两组患者麻醉效果、麻醉药物用量和不良反应发生率，同时比较各时间点血清皮质醇（Cor）和简易精神状态检查量表（MMSE）评分。结果 观察组麻醉优良率（94.12%）明显高于对照组（76.47%）（P < 0.05）；观察组各麻醉药物用量明显少于对照组（P < 0.05）；观察组术后1和3 d血清Cor水平明显低于对照组（P < 0.05）；观察组术后1和3 d MMSE评分明显高于对照组（P < 0.05）；观察组不良反应总发生率（14.71%）明显低于对照组（38.24%）（P < 0.05）。结论 老年患者TEM术中采用右美托咪定复合麻醉能够提高麻醉效果，减轻术后应激反应，改善术后认知功能，考虑与右美托咪定减少了术中各麻醉药物用量及增强各麻醉药物效果有关。

Abstract:

Objective To explore the effect of different anesthetic methods applied to transanal endoscopic microsurgery (TEM) on cognitive function and anesthetic quality in elderly patients.Methods 68 elderly patients underwent TEM surgery from January 2018 to June 2019 were selected. They were divide the control group and the observation group by random digital table method, 34 cases in each group. The anesthetic effect, the dosage of narcotic drugs and the incidence of adverse reactions were compared between the two groups. And the concentration of serum cortisol (Cor) and simple mental state evaluation scale (MMSE) were compared at each time point.Results Excellent rate of anesthesia in the observation group (94.12%) was significantly higher than that in the control group (76.47%) (P < 0.05); All the anesthetics in the observation group were significantly lower than those in the control group (P < 0.05). The concentration of serum Cor in the observation group were significantly lower than those in the control group 1 d and 3 d after operation (P < 0.05). The MMSE score of observation group were significantly higher than those in the control group 1 d and 3 d after operation (P < 0.05). Overall incidence of adverse reactions in the observation group (14.71%) was significantly lower than that in the control group (38.24%) (P < 0.05).Conclusion Combined anesthesia with dexmedetomidine during operation of TEM in elderly patients can improve the anesthesia effect, reduce postoperative stress response, improve postoperative cognitive function. It is considered to be related to the reduction of the dosage of each narcotic drug and the enhancement of the effect of each narcotic drug.