【罂粟摘要】不同输注速度的丙泊酚对老年腹腔镜腹股沟疝修补术后认知的影响

不同输注速度的丙泊酚对老年腹腔镜腹股沟疝修补术后认知的影响

贵州医科大学麻醉与心脏电生理课题组

翻译：马艳燕  

编辑：宋雨婷 

审校：曹莹

目的

本研究旨在探讨不同输注速度的丙泊酚对腹腔镜腹股沟疝修补术老年患者术后认知功能的影响。

方法

将180例计划行腹腔镜腹股沟疝修补术的老年患者随机分为3组：丙泊酚缓慢输注组（VS组，30mg/kg/h)；丙泊酚中速输注组（VM组，100mg/kg/h）或丙泊酚快速输注组（VF组，300mg/kg/h)。采用微量输注泵输注丙泊酚进行麻醉诱导，用脑电双频指数（BIS）监测麻醉深度。丙泊酚和瑞芬太尼在麻醉维持期间连续输注，并根据BIS进行调整。主要指标是使用简易智力状况检查法（MMSE）和蒙特利尔认知评估量表（MoCA）来评估老年患者在术后第1天和第7天认知功能下降（POCD）的发生率。次要指标包括丙泊酚的诱导剂量、爆发抑制的发生率和丙泊酚诱导期间的最大脑电效应(BIS-min)。

结果

术后第1天和第7天，三组POCD发生率无显著差异(P >0.05)。然而，随着丙泊酚输注速度、丙泊酚诱导剂量、爆发抑制发生率和诱导期间BIS-min的增加，需要血管活性药物的患者数显著增加（P <0.001）。多因素回归分析显示，诱导期间短时间的爆发抑制不影响POCD的发生，而年龄和住院时间是POCD的危险因素。

结论

对于行腹腔镜腹股沟疝修补术的老年患者，降低丙泊酚输注速率（如30 mg/kg/h）并不能降低早期POCD的发生率，但减少丙泊酚的诱导剂量和血管活性药物的使用可使患者的血流动力学更加稳定。

原始文献来源

Li T, Han W, Yang X, et al. Effects of Different Injection Rates of Propofol on Postoperative Cognition in Elderly Patients Undergoing Laparoscopic Inguinal Hernia Repair. Drug Des Devel Ther. 2023;17:1741-1752. Published 2023 Jun 13. 

英文原文

Effects of Different Injection Rates of Propofol on Postoperative Cognition in Elderly Patients Undergoing Laparoscopic Inguinal Hernia Repair

Purpose: This study aimed to explore the effects of different injection rates of propofol on postoperative cognition in elderly patients undergoing laparoscopic inguinal hernia repair.

Methods: A total of 180 elderly patients who planned to undergo laparoscopic inguinal hernia repair were randomly divided into three groups: slow injection of propofol (VS-Group, 30 mg kg− 1 h− 1); medium injection of propofol (VM-Group, 100 mg kg− 1 h− 1) or fast injection of propofol (VF-Group, 300 mg kg− 1 h− 1). Propofol was induced by microinfusion pump, and the depth of anesthesia was monitored by bispectral index (BIS). Propofol and remifentanil were continuously infused during anesthesia maintenance and adjusted according to BIS. The primary outcome was the use of the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) to measure the incidence of postoperative cognitive decline (POCD) in elderly patients on the first and seventh postoperative day. Secondary outcomes included induced dose of propofol, incidence of burst suppression and maximum electroencephalographic (EEG) effect of propofol (BIS-min) during induction.

Results: The incidence of POCD on the first and seventh day postoperatively was similar among the three groups (P > 0.05). However, with the increase of propofol injection rate, induced dose of propofol, incidence of burst suppression and BIS-min during induction, the number of patients requiring vasoactive agents were significantly increased (P < 0.001). Multivariate regression analysis showed that the brief duration of burst suppression during induction did not affect the occurrence of POCD, while age and duration of hospitalization were risk factors for POCD.

Conclusion: For elderly patients undergoing laparoscopic inguinal hernia repair, lowering the injection rate of propofol (such as 30 mg kg− 1 h− 1) cannot decrease the incidence of early POCD, but reduces induction dose of propofol and use of vasoactive drugs, making the patient’s hemodynamics more stable.

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