喉罩下两种不同浓度七氟烷对腹腔镜胆囊手术患者麻醉效果的影响

Effects of two different concentrations of sevoflurane on anesthetic outcomes in patients undergoing laparoscopic cholecystectomy with laryngeal mask airway

摘要:

目的 探讨喉罩下两种不同浓度七氟烷对腹腔镜胆囊手术患者麻醉效果的影响。方法 选取2022年3月—2023年3月在山东省立第三医院105例行腹腔镜胆囊手术患者作为研究对象，按信封抽签法随机分为A组、B组和C组，每组35例。A组给予丙泊酚麻醉，B组给予1%七氟烷麻醉，C组给予3%七氟烷麻醉。比较3组患者围手术期指标和各时间点的平均动脉压（MAP）、心率（HR）、视觉模拟评分法（VAS）评分、氧化应激指标、简易智能精神状态量表（MMSE）评分、Ramsay镇静评分、不良反应。结果 B组苏醒时间、拔管时间短于A组、C组（P <0.05）。各组患者诱导时间、恢复室停留时间比较，差异均无统计学意义（P >0.05）。各组患者麻醉诱导前、麻醉15 min（T₁）、30 min（T₂）、45 min（T₃）、拔管后的MAP、HR比较，结果 ①不同时间点MAP、HR比较，差异均有统计学意义（P <0.05）；②各组患者MAP、HR比较，差异均有统计学意义（P <0.05），C组在T₂、T₃时间点MAP低于A组和B组，在T₁、T₂时间点HR低于A组和B组；③各组患者MAP变化趋势比较，差异无统计学意义（P >0.05），各组患者HR变化趋势比较，差异有统计学意义（P <0.05）。各组患者术后1、6和12 h的VAS评分比较，结果 ①不同时间点VAS评分比较，差异有统计学意义（P <0.05）；②各组患者VAS评分比较，差异有统计学意义（P <0.05），C组VAS评分较A组、B组低，相对镇痛效果较好；③各组患者VAS评分变化趋势比较，差异有统计学意义（P <0.05）。C组手术前后SOD、MDA、T-AOC的差值低于A组、B组（P <0.05）。各组患者术前和术后1、3 h MMSE评分、Ramsay镇静评分比较，结果 ①不同时间点MMSE评分、Ramsay镇静评分比较，差异均有统计学意义（P <0.05）；②各组患者MMSE评分、Ramsay镇静评分比较，差异均有统计学意义（P <0.05），C组在术后1、3 h的MMSE评分高于A组、B组，Ramsay镇静评分低于A组、B组；③各组患者MMSE评分、Ramsay镇静评分变化趋势比较，差异均有统计学意义（P <0.05）。各组患者不良反应总发生率比较，差异无统计学意义（P >0.05）。结论 喉罩下1%浓度七氟烷苏醒时间和拔管时间较短，但3%浓度的七氟烷对腹腔镜胆囊手术患者的麻醉效果较好，用药安全性有保障。

Abstract:

Objective To investigate the effects of two different concentrations of sevoflurane on anesthetic outcomes in patients undergoing laparoscopic cholecystectomy with laryngeal mask airway.Methods From March 2022 to March 2023, 105 patients undergoing laparoscopic cholecystectomy at Shandong Provincial Third Hospital were selected and randomly divided into group A, group B, and group C, each comprising 35 individuals. Group A received cyclopol anesthesia, group B was administered 1% sevoflurane, and group C was given 3% sevoflurane. The perioperative indicators, mean arterial pressure (MAP), heart rate (HR), VAS scores, oxidative stress indicators, MMSE scores, and Ramsay sedation scores at various time points, and adverse reactions were compared among the three groups.Results The time to recovery and extubation in the group B was shorter than that in the group A and group C (P <0.05). There was no difference in the induction time and time spent in the recovery room among the groups as determined by one-way ANOVA (P > 0.05). Comparison of MAP and HR among the three groups at T₀, T₁, T₂, T₃ and T₄ via repeated measures ANOVA showed that they were different among the time points (P < 0.05) and among the groups (P < 0.05). In group C, MAP at T₂ and T₃ was lower than that of groups A and B, and HR at T₁ and T₂ was lower than that of groups A and B. The change trend of MAP was not different (P > 0.05) but that of HR was different (P < 0.05) among the groups. Comparison of VAS scores 1 h, 6 h and 12 h after surgery among the three groups showed that they were different among the time points (P < 0.05) and among the groups (P < 0.05). The VAS scores in the group C were lower than those in the groups A and B, indicating better analgesic effects. The change trend of the VAS scores was different among the groups (P < 0.05). The differences in levels of superoxide dismutase (SOD) and malondialdehyde (MDA) as well as total antioxidant capacity (T-AOC) before and after surgery in the group C were lower than those in the groups A and B (P < 0.05). Comparison of MMSE scores and Ramsay sedation scores before and 1 h and 3 h after the surgery among the three groups showed that they were different among the time points (P < 0.05) and among the groups (P < 0.05). The MMSE scores 1 h and 3 h after surgery in the group C were higher than those in the groups A and B, while the Ramsay sedation scores in the group C were lower than those in the groups A and B. The change trends of MMSE scores and Ramsay sedation scores were also different among the groups (P < 0.05). There was no statistically significant difference in the overall incidence of adverse reactions among the three groups (P > 0.05).Conclusions With laryngeal mask airway, the time to recovery and extubation is shorter when 1% sevoflurane is applied, but 3% sevoflurane provides better anesthesia effects for patients undergoing laparoscopic cholecystectomy, with the drug's safety also being ensured.