静吸复合麻醉与全凭静脉麻醉在老年腹腔镜手术患者中的麻醉效果对比观察

目的探讨静吸复合麻醉与全凭静脉麻醉在老年腹腔镜手术患者中的麻醉效果。方法 78例老年腹腔镜手术患者,随机分为对照组和观察组,各39例。对照组给予静吸复合麻醉,观察组给予全凭静脉麻醉。比较两组麻醉前、术毕、术后3 d的NK、CD3^+、CD4^+和CD4^+/CD8^+水平。比较两组气腹前后的CO2、pH、碱剩余和CO2总量水平。结果麻醉前,两组NK、CD3^+、CD4^+、CD4^+/CD8^+免疫功能指标水平比较,差异均无统计学意义(P>0.05);术毕,两组NK、CD3^+、CD4^+、CD4^+/CD8^+免疫功能指标水平均较本组麻醉前降低,但观察组均高于对照组,差异均具有统计学意义(P<0.05);术后3 d,两组NK、CD3^+、CD4^+、CD4^+/CD8^+免疫功能指标水平均较本组术毕升高,差异均具有统计学意义(P<0.05);但与本组麻醉前及两组间比较,差异均无统计学意义(P>0.05)。气腹前,两组CO2分压、pH值、碱剩余、CO2总量水平比较,差异均无统计学意义(P>0.05);气腹后,观察组CO2分压、pH值、碱剩余、CO2总量水平与本组气腹前比较差异均无统计学意义(P>0.05),对照组CO2分压、pH值、碱剩余、CO2总量水平与本组气腹前比较差异均具有统计学意义(P<0.05),且观察组CO2分压(4.51±0.82)kPa、碱剩余(-5.56±1.47)mmol/L、CO2总量(18.74±1.36)mmol/L均低于对照组的(6.07±1.78)kPa、(-6.91±1.93)mmol/L、(22.37±2.34)mmol/L, pH值(7.36±0.07)高于对照组的(7.15±0.06),差异均具有统计学意义(P<0.05)。结论静吸复合麻醉和全凭静脉麻醉都有各自的优点,而从整体效果上看。全凭静脉麻醉的麻醉效果要比静吸复合麻醉的麻醉效果略高一些,另外,使用全凭静脉麻醉的患者术后头痛、恶心呕吐、苏醒期躁动等不良反应的发生率更低,值得广泛应用。

Comparative observation on anesthesia effect between intravenous inhalation combined anesthesia and total intravenous anesthesia in elderly patients undergoing laparoscopic surgery

Objective To discuss the anesthesia effect between intravenous inhalation combined anesthesia and total intravenous anesthesia in elderly patients undergoing laparoscopic surgery. Methods A total of 78 elderly patients undergoing laparoscopic surgery were randomly divided into control group and observation group, with 39 cases in each group. The control group received intravenous inhalation combined anesthesia, and the observation group group received total intravenous anesthesia. The levels of natural killer(NK), CD3^+, CD4^+ and CD4^+/CD8^+ before anesthesia, immediately after operation and 3 d after operation between the two groups were compared. The levels of CO2 partial pressure, pH value, base excess and total amount of CO2 before and after pneumoperitoneum were compared between the two groups. Results Before anesthesia, there was no statistically significant difference in levels of immune function indexes of NK, CD3^+, CD4^+ and CD4^+/CD8^+ between the two groups(P>0.05). After operation, the levels of immune function indexes of NK, CD3^+, CD4^+ and CD4^+/CD8^+ in the two groups were decreased than those before anesthesia, but the observation group was higher than the control group. Their difference was statistically significant(P<0.05). At 3 d after operation, the levels of immune function indexes of NK, CD3^+, CD4^+ and CD4^+/CD8^+ in the two groups were higher than those before operation, and their difference was statistically significant(P<0.05). However, there was no significant difference between the two groups and compared with those before anesthesia(P>0.05). Before pneumoperitoneum, there was no statistically significant difference in levels of CO2 partial pressure, pH value, base excess and total amount of CO2 between the two groups(P>0.05). After pneumoperitoneum, there were no statistically significant differences in the levels of CO2 partial pressure, pH value, base excess and total amount of CO2 between the observation group and the group before pneumoperitoneum(P>0.05). There were statistically significant differences in the levels of CO2 partial pressure, pH value, base excess and total amount of CO2 between the control group and the group before pneumoperitoneum(P<0.05). The CO2 partial pressure(4.51±0.82) kPa, base excess(-5.56±1.47) mmol/L and total amount of CO2(18.74±1.36) mmol/L in the observation group were lower than(6.07±1.78) kPa,(-6.91± 1.93) mmol/L and(22.37±2.34) mmol/L in the control group, and pH value(7.36±0.07) was higher than(7.15±0.06) in the control group. Their difference was statistically significant(P<0.05). Conclusion Both intravenous inhalation combined anesthesia and total intravenous anesthesia have their own advantages. In terms of the overall effect, the anesthesia effect of total intravenous anesthesia is slightly higher than that of intravenous inhalation combined anesthesia. In addition, the incidence of adverse reactions such as headache, nausea and vomiting, restlessness in the wake-up period of patients using total intravenous anesthesia is lower, which is worthy of wide application.