地氟烷在老年糖尿病患者全身麻醉中的应用研究

Application of desflurane in general anesthesia of elderly patients with diabetes

摘要:

目的 观察地氟烷在老年糖尿病患者全身麻醉中的应用效果。方法 本研究为前瞻性研究，选择安阳市人民医院2021年3月至2023年6月收治的112例老年糖尿病手术患者为研究对象，依据入院顺序，以随机数字表法将其列为常规组和试验组各56例；常规组实施常规全身麻醉，试验组采用地氟烷辅助全身麻醉，比较两组患者的术后镇痛、镇静效果，神经功能，认知功能，苏醒情况及麻醉相关副反应发生情况。结果 试验组术后6 h、12 h、48 h的视觉模拟疼痛量表（VAS）评分分别为（4.25±1.33）分、（3.65±0.53）分、（2.77±0.36）分，均低于常规组［（5.18±1.76）分、（4.31±1.72）分、（3.55±0.82）分］（P<0.05）；试验组术后6 h、12 h、48 h的Ramsay镇静评分（RSS）分别为（3.77±0.46）分、（3.36±0.25）分、（3.11±0.16）分，均高于常规组［（3.02±0.69）分、（2.73±0.65）分、（2.31±0.59）分］（P<0.05）；试验组术后的神经元特异性烯醇化酶（NSE）、中枢神经特异蛋白（S100β）分别为（15.35±3.27）ng/mL、（12.29±3.14）pg/mL，均低于常规组［（18.64±4.25）ng/mL、（15.18±3.76）pg/mL］（P<0.05）；试验组术后的简易智力状态检查量表（MMSE）、蒙特利尔认知评估量表（MoCA）评分分别为（24.12±5.28）分、（24.33±5.72）分，均高于常规组［（21.45±5.36）分、（21.29±5.31）分］（P<0.05）；试验组的睁眼时间、定向力恢复时间、拔管时间、住院时间分别为（15.44±3.46）min、（17.62±4.14）min、（24.11±5.15）h、（10.32±2.49）d，略高于常规组［（14.45±3.13）min、（16.19±4.21）min、（22.36±5.27）h、（9.63±1.79）d］，但差异无统计学意义（P>0.05）；试验组麻醉相关副反应发生率为14.29%（8/56），略高于常规组［10.71%（6/56）］，差异无统计学意义（P>0.05）。结论 地氟烷辅助全身麻醉能增强老年糖尿病手术患者的术后镇痛、镇静效果，可在不明显影响苏醒质量，或增加麻醉风险基础上，有效避免神经功能损伤，并改善术后认知功能。

Abstract:

Objective To observe the effect of desflurane on general anesthesia in elderly patients with diabetes.Methods This study is a prospective study. A total of 112 elderly patients with diabetes who were admitted to Anyang People's Hospital from March 2021 to June 2023 were selected as the study subjects. According to the order of admission, they were classified into the conventional group (56 cases) and the experimental group (56 cases) by random number table. The conventional group was given conventional general anesthesia, and the experimental group was given desflurane assisted general anesthesia. The postoperative analgesic and sedative effects, neurological functions, cognitive functions, awakening situation and the occurrence of anesthesia related side effects of the patients in the two groups were compared.Results Under different anesthesia regimens, the VAS scores of the experimental group at 6h, 12h, and 48h after surgery were 4.25±1.33 points, 3.65±0.53 points, and 2.77±0.36 points, lower than the conventional group (5.18±1.76 points, 4.31±1.72 points, and 3.55±0.82 points); the RSS scores of the experimental group were 3.77±0.46 points, 3.36±0.25 points, and 3.11±0.16 points, higher than the conventional group (3.02±0.69 points, 2.73±0.65 points, and 2.31±0.59 points) (P<0.05). NSE and S100β of the experimental group were 15.35±3.27 ng/mL and 12.29±3.14 pg/mL, lower than the conventional group (18.64±4.25 ng/mL and 15.18±3.76 pg/mL) (P<0.05). The MMSE and MoCA scores of the experimental group were 24.12±5.28 points and 24.33±5.72 points, higher than the conventional group (21.45±5.36 points and 21.29±5.31 points) (P<0.05). The eye opening time, directional force recovery time, extubation time, and hospitalization time of the experimental group were 15.44±3.46 minutes, 17.62±4.14 minutes, 24.11±5.15 hours, and 10.32±2.49 days, slightly higher than the conventional group (14.45±3.13 minutes, 16.19±4.21 minutes, 22.36±5.27 hours, and 9.63±1.79 days) (P>0.05). The incidence of anesthesia related side effects was 14.29% (8/56), slightly higher than the conventional group [10.71% (6/56)] (P>0.05).Conclusion Desflurane assisted general anesthesia can enhance the postoperative analgesia and sedation effect of elderly patients with diabetes undergoing surgery. It can effectively avoid neurological damage and improve postoperative cognitive function without significantly affecting the quality of recovery or increasing the risk of anesthesia.