老年骨科患者应用依托咪酯行静脉麻醉对其术后认知功能及术中应激反应的影响

摘要

Objective To investigate the safety of intravenous anesthesia with Etomidate in elderly orthopedic patients. Methods 150 cases of elderly orthopedic patients from March 2015 to March 2017 were divided into the control group and the observation group according to the random number table method, 75 cases for each group. All patients were treated with intravenous anesthesia, in which the control group was induced with propofol and maintained anesthesia; the observation group was given Etomidate induced and maintained anesthesia. The complications of the two groups were recorded at the first day and the seventh days after operation. The levels of cortisol were measured before anesthesia, the complete time of operation and 24 hours after operation. Results The complication rate in the observation group was 21.33% (16/75) compared with 26.67% (20/75) in the control group; the cognitive impairment rate was 24.6% (18/75) and 12.0% (9/75) of the control group, the cognitive dysfunction rate was 26.67% and 13.33%, and there was no significant difference between two groups. The concentration of cortisol in the two groups was significantly lower than that before operation, and the concentration of cortisol in the observation group was significantly lower than the control group (P<0.05). There was no significant difference in the concentration of cortisol restoring to preoperative levels at 24h after operation in two groups. Conclusion The application of Etomidate in elderly orthopedic surgery with intravenous anesthesia could not increase the incidence of cognitive dysfunction in patients, however, inhibition of stress response of Etomidate was better than propofol.%目的 探讨老年骨科患者应用依托咪酯行全凭静脉麻醉的安全性.方法 选取2015年3月~2017年3月浙江衢化医院收治的150例老年骨科患者,按照随机数字表法将其分为对照组与观察组,各75例.所有患者均行全凭静脉麻醉,其中对照组采用丙泊酚诱导和维持麻醉;观察组采用依托咪酯诱导和维持麻醉.记录2组并发症情况,评价2组术后1 d、7 d认知功能状况,分别于麻醉前、手术完成及术后24h检测2组皮质醇水平.结果 观察组并发症率21.33%(16/75)与对照组26.67%(20/75)比较,差异无统计学意义.观察组患者术后1 d、7 d认知功能障碍率24.0%、12.0%与对照组26.67%、13.33%比较,差异无统计学意义.2组患者手术完成时皮质醇浓度较术前显著下降,且观察组下降较对照组显著(P<0.05);2组于术后24 h时皮质醇浓度基本恢复至术前状况,组间比较无统计学意义.结论 老年骨科手术全凭静脉麻醉应用依托咪酯并不会增加患者术后认知功能障碍发生率,但依托咪酯抑制应激反应程度较丙泊酚强.