不同浓度七氟烷吸入麻醉对非体外循环冠脉搭桥手术患者苏醒质量、心肾功能和认知功能的影响

摘要 目的：探讨不同浓度七氟烷吸入麻醉对非体外循环冠脉搭桥手术（OPCABG）患者苏醒质量、心肾功能和认知功能的影响。方法：选取我院2018年5月~2021年3月期间收治的行OPCABG患者93例，采用随机数字表法将受试对象随机分为A组（舒芬太尼、丙泊酚，31例）、B组（舒芬太尼、丙泊酚、0.5 MAC七氟烷，31例）和C组（舒芬太尼、丙泊酚、1.0 MAC七氟烷，31例）。观察三组患者血流动力学心率（HR）和平均动脉压（MAP）]、苏醒质量、心肾功能心肌肌钙蛋白I（cTnI）、肌酸激酶（CK-MB）/肌酐（Scr）、尿素氮（BUN）]和认知功能简易精神状态测量量表（MMSE）、蒙特利尔认知功能评估量表（MoCA）评分]的变化，记录三组不良反应发生情况。结果：三组术后即刻（T1）~术后24h（T3）时间点HR升高后下降，MAP下降后升高（P<0.05）；B组T1、术后6 h（T2）时间点HR低于A组、C组，MAP高于A组、C组（P<0.05）；A组与C组T1、T2时间HR、MAP组间对比无显著性差异（P>0.05）。三组苏醒期躁动发生率组间对比无统计学差异（P>0.05）；B组术后苏醒时间短于A组、C组（P<0.05）；A组与C组术后苏醒时间组间对比无显著性差异（P>0.05）。三组的cTnI、CK-MB、Scr、BUN水平相较于麻醉开始前（T0）时间点均升高（P>0.05）；B组T3时间点cTnI、CK-MB、Scr、BUN水平低于A组、C组（P<0.05）。B组术后第3 d MMSE、MoCA评分高于A组、C组（P<0.05）。三组不良反应发生率对比无差异（P>0.05）。结论：OPCABG患者在舒芬太尼、丙泊酚麻醉的基础上结合七氟烷吸入麻醉，可更好的稳定血流动力学，减轻对机体心肾功能和认知功能的影响，提高苏醒质量，且以0.5 MAC浓度的七氟烷综合效果最佳。

Effects of Sevoflurane Inhalation Anesthesia with Different Concentrations on Wake-Up Quality, Cardiorenal Function and Cognitive Function in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting

ABSTRACT Objective: To investigate the effects of sevoflurane inhalation anesthesia with different concentrations on awakening quality, cardiorenal function and cognitive function in patients undergoing off-pump coronary artery bypass grafting (OPCABG). Methods: 93 patients with OPCABG who were treated in our hospital from May 2018 to March 2021 were selected, and they were randomly divided into group A (sufentanil, propofol, 31 cases) and group B (sufentanil, propofol, 0.5MAC sevoflurane, 31 cases) and group C (sufentanil, propofol, 1.0MAC sevoflurane, 31 cases). The hemodynamics heart rate (HR) and mean arterial pressure (MAP)], waking quality, cardiorenal function cardiac troponin I (cTnI), creatine kinase (CK-MB) / creatinine (Scr), urea nitrogen (BUN)] and cognitive function mini-mental state examination (MMSE) and Montreal cognitive function assessment scale (MoCA) score] in three groups of patients were observed, and the occurrence of adverse reactions in the three groups were recorded. Results: The HR increased and then decreased, the MAP decreased and then increased in the three groups from immediately after operation (T1) to 24 h after operation (T3) (P<0.05). The HR in group B at T1 and 6h after operation (T2) werer lower than that in group A and group C, and the MAP was higher than that in group A and group C (P<0.05). There was no significant difference in HR and MAP between group A and group C at T1 and T2 (P>0.05). There were no significant differences in the incidence of agitation during awakening among the three groups (P>0.05). The postoperative awakening time in group B was shorter than that in group A and group C (P<0.05). There was no significant difference in postoperative awakening time between group A and group C (P>0.05). The levels of cTnI, CK-MB, Scr and BUN in the three groups were higher than those before anesthesia (T0) (P>0.05). The cTnI, CK-MB, Scr and BUN levels in group B at T3 were less than those in group A and group C (P<0.05). MMSE and MoCA scores in group B at the 3rd day after operation were higher than those in group A and group C (P<0.05). There were no differences in the incidence of adverse reactions among the three groups (P>0.05). Conclusion: In patients with OPCABG, sevoflurane inhalation anesthesia combined with sufentanil and propofol anesthesia can better stabilize hemodynamics, reduce the impact on cardiorenal function and cognitive function, and improve the awakening quality, and sevoflurane at 0.5 MAC concentration has the best comprehensive effect.