纳美芬处理腹腔镜胆囊切除术治疗胆囊结石患者苏醒和认知功能变化研究*

doi:10.3969/j.issn.1672-5069.2024.05.035

摘要/Abstract

摘要： 目的探讨应用纳美芬对腹腔镜胆囊切除术(LC)治疗的胆囊结石患者麻醉苏醒和认知功能的影响。方法 2022年2月～2023年12月我科诊治的胆囊结石患者94例,被随机分为观察组47例和对照组47例。两组均接受LC手术,常规接受诱导和维持静脉麻醉。在手术结束时,给予观察组患者纳美芬,而给予对照组等容量生理盐水静脉注射。采用Riker镇静-躁动评分量表(RSAS)评估苏醒期躁动,采用视觉模拟疼痛评分(VAS)评估疼痛,采用简易智力状态检测量表(MMSE)评估认知功能,采用ELISA法检测血清可溶性中枢神经特异蛋白(S100β)和神经元特异性烯醇化酶(NSE)水平。结果观察组自主呼吸恢复时间为(7.1±1.3)min、睁眼时间为(8.5±1.4)min、拔管时间为(10.5±1.9)min和定向力恢复时间为(13.6±2.2)min,均显著短于对照组【分别为(9.3±1.5)min、(10.4±1.7)min、(14.3±2.8)min和(18.4±2.7)min,P＜0.05】;两组RSAS评分差异无统计学意义(P＞0.05),但拔管后30 min、60 min和3 h时,观察组VAS评分分别为(2.8±0.5)分、(3.2±0.8)分和(3.5±0.4)分,均显著低于对照组【分别为(3.8±0.9)分、(4.1±0.7)分和(4.3±0.6)分,P＜0.05】;在术后1 d和3 d时,观察组MMSE评分分别为(26.8±1.0)分和(27.7±0.7)分,均显著高于对照组【分别为(25.1±0.9)分和(26.0±0.8)分,P＜0.05】;在术后1 d时,观察组血清NSE和S100β水平分别为(14.7±2.1)μg/L和(155.6±17.8)pg/mL,均显著低于对照组【分别为(17.3±2.7)μg/L和(169.5±20.4)pg/mL,P＜0.05】。结论在常规结束麻醉时静脉给予纳美芬处理完成LC手术治疗的胆囊结石患者可有效缩短麻醉苏醒时间,减轻术后疼痛,加快认知功能的恢复。

关键词: 胆囊结石, 腹腔镜胆囊切除术, 麻醉, 纳美芬, 苏醒, 认知功能

Abstract: Objective The aim of this study was to investigate effects of nalmefene on cognitive function recovery after anesthesia in patients with cholecystolithiasisundergoing laparoscopic cholecystectomy (LC). Methods 94 patients with gallstones were enrolled in our hospital between February 2022 and December 2023, and all underwent LC surgery. At end of conventional anesthesia, patients were randomly assigned to receive nalmefene in observation (n=47) or normal saline in control (n=47) to improve recovery. Emergence agitation was evaluated by Richmond sedation-agitation scale (RSAS), postoperative pain was evaluated by visual analogue scale (VAS), and postoperative cognitive function was evaluated by mini-mental state examination (MMSE). Serum soluble protein-100β (S100β) and neuron-specific enolase (NSE) levels were detected by ELISA. Results Spontaneous respiration recovery, eye opening, extubation time and orientation recovery in observation group were (7.1±1.3) min, (8.5±1.4)min, (10.5±1.9)min and (13.6±2.2)min, all significantly shorter than [(9.3±1.5)min, (10.4±1.7)min, (14.3±2.8)min and (18.4±2.7)min, respectively, P＜0.05] in the control; there was no significant difference respect to RSAS scores between the two groups (P＞0.05), while 30min, 60min and 3hours after extubation,VAS scores in the observation were (2.8±0.5)points, (3.2±0.8)points and (3.5±0.4)points, all much lower than [(3.8±0.9)points, (4.1±0.7)points and (4.3±0.6)points, P＜0.05] in the control; one and three days after operation, MMSE score in the observation were (26.8±1.0)points and (27.7±0.7)points, both significantly higher than [(25.1±0.9)points and (26.0±0.8)points, P＜0.05] in the control; one day after surgery, serum NSE and S100β levels in the observation were (14.7±2.1)μg/L and (155.6±17.8)pg/mL, both much lower than [(17.3±2.7)μg/L and (169.5±20.4)pg/mL, P＜0.05]in the control group. Conclusion Administration of nalmefene at end of conventional anesthesia could relieve postoperative pain and accelerate cognitive function recovery in patients with cholecystolithiasis after LC operation.

Key words: Cholecystolithiasis, Laparoscopic cholecystectomy, Anesthesia, Nalmefene, Recoveryquality, Cognitive function

向红, 叶立, 黄建峰. 纳美芬处理腹腔镜胆囊切除术治疗胆囊结石患者苏醒和认知功能变化研究^*[J]. 实用肝脏病杂志, 2024, 27(5): 785-788.

Xiang Hong, Ye Li, Huang Jianfeng. Nalmefene improves cognitive function recovery after anesthesia in patients with cholecystolithiasis undergoing laparoscopic cholecystectomy[J]. Journal of Practical Hepatology, 2024, 27(5): 785-788.

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纳美芬处理腹腔镜胆囊切除术治疗胆囊结石患者苏醒和认知功能变化研究^*

Nalmefene improves cognitive function recovery after anesthesia in patients with cholecystolithiasis undergoing laparoscopic cholecystectomy

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