丙泊酚与七氟烷分别联合右美托咪定对骨肿瘤手术患者术后认知功能、血沉及氧化应激产物的影响

摘要

目的：探讨丙泊酚与七氟烷分别联合右美托咪定对骨肿瘤手术患者术后认知功能、血沉及氧化应激产物的影响及其意义。方法选取解放军117医院已确诊为骨肿瘤且需要手术治疗的患者52例，采用随机数字表法将患者随机分为七氟烷组和丙泊酚组，七氟烷组在麻醉维持时同时应用七氟烷和右美托咪定；丙泊酚组患者在麻醉维持时同时应用丙泊酚和右美托咪定。手术结束后比较2组患者的认知功能评分、苏醒时间、血沉值以及氧化应激产物水平。结果与丙泊酚组同时段比较，术后6、12、24 h七氟烷组认知功能评分较高（P＜0．05），在24 h七氟烷组认知功能评分恢复至术前水平。七氟烷组自主呼吸、睁眼、拔除气管插管以及定向力恢复时间均短于丙泊酚组（P＜0．05）。与丙泊酚组同时段比较，术后5、10 d七氟烷组血沉值较低（P＜0．05），七氟烷组在术后10 d其血沉值恢复至术前水平。与丙泊酚组术后比较，七氟烷组患者超氧化物岐化酶（superoxide dismutase，SOD）、丙二醛（methane dicarboxylic aldehyde，MDA）水平显著降低（P＜0．05），七氟烷组总抗氧化能力（total antioxidant capacity，T－AOC）水平显著升高（P＜0．05）。结论七氟烷联合右美托咪定相对丙泊酚联合右美托咪定对骨肿瘤患者术后认知功能的影响更小，对临床手术治疗骨肿瘤具有重要意义。%Objective To explore effect of propofol or sevoflurane combined with dexmedetomidine on postoperative cognitive function , erythrocyte sedimentation rate and oxidative stress in patients with bone tumour .Methods 52 cases with bone tumor and requiring a surgery were selected and divided into sevoflurane group and propofol group randomly.The sevoflurane group were anesthetized with sevoflurane and dexmedetomidine.Propofol group were anesthetized with propofol and dexmedetomidine.The cognitive function score, recovery time, sedimentation value and oxidative stress level were compared after operation.ResuIts Compared with propofol group at the same time, the cognitive function score of patients in sevoflurane group at postoperative 6, 12, 24 h were higher (P<0.05) and restored to preoperative levels at postoperative 24 h (P<0.05) .The recovery time of spontaneous breathing, eyes open, remove endotracheal intubation and directional force in sevoflurane group were shorter than that in propofol group (P<0.05).Compared with propofol group at the same time, the erythrocyte sedimentation rate in sevoflurane group at postoperative 5, 10d were lower (P<0.05) and restored to preoperative levels at postoperative 10 d (P<0.05).Compared with propofol group postoperation, the superoxide dismutase (SOD) and methane dicarboxylic aldehyde (MDA) levels in sevoflurane group were lower, total antioxidant capacity (T-AOC) level was higher (P<0.05).ConcIusion Sevoflurane has a smaller effect on postoperative cognitive function than propofol in patients with bone tumor, combined with dexmedetomidine, which has an important significance to clinical surgery.