丙泊酚联合艾司胺酮麻醉诱导对老年患者围术期应激和炎症反应及术后认知的影响

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丙泊酚联合艾司胺酮麻醉诱导对老年患者围术期应激和炎症反应及术后认知的影响
翻译：吴学艳编辑：佟睿审校：曹莹
贵州医科大学高鸿教授课题组
目的分析丙泊酚联合艾司氯胺酮麻醉诱导对老年患者围手术期应激、炎症反应及术后认知的影响。
方法将80例老年外科手术患者随机分为对照组(n=40)和实验组(n=40) ，对照组给予丙泊酚联合舒芬太尼诱导，实验组使用丙泊酚联合艾司氯胺酮麻醉诱导；比较两组患者的血流动力学、应激和炎症反应、认知功能变化、围术期相关指标及不良反应情况。
两组患者T1时的肾上腺素、去甲肾上腺素、内皮素、C反应蛋白、白细胞、降钙素原水平与T0时相比无明显变化， T2、T3时的各指标水平均较T1时升高，而T4的各项指标水平与T0接近，且实验组高于对照组，上述指标在组间、时间点上、组与时间点之间交互水平比较，差异均具有统计学意义(P<0.05) 。术后24h ，两组患者蒙特利尔认知评估量表(MoCA)评分均下降，且实验组MoCA评分高于对照组(P<0.05)；实验组麻醉时间及意识恢复时间均短于对照组(P<0.05) 。注：（麻醉前(T0)、麻醉开始时(T1)、麻醉后30 min (T2)、手术结束时(T3)、术后12 h (T4)）
结论丙泊酚联合艾司氯胺酮麻醉诱导，具有良好的安全性和可靠性，可改善血流动力学及手术应激及炎症反应，缩短麻醉时间，促进术后认知功能恢复，不良反应相对较轻。

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Influence of anesthetic induction of propofol combined with esketamine on perioperative stress and inflammatory responses and postoperative cognition of elderly surgical patients
Abstract
Objective: To analyze the influence of anesthetic induction of propofol combined with esketamine on perioperative stress and inflammatory responses and postoperative cognition in elderly surgical patients.
Methods: A total of 80 elderly surgical patients were randomly divided into a control group (n=40) and a study group (n=40). The control group received anesthetic induction with propofol combined with sufentanil, while the study group received anesthetic induction with propofol combined with esketamine. Hemodynamics, stress and inflammatory responses and changes in cognitive function, perioperative related indexes and adverse responses were compared between the two groups.
Results: At T1, the levels of adrenaline, norepinephrine, endothelin, C-reactive protein, white blood cell and procalcitonin in the two groups were not markedly changed compared with those at T0. The levels of the indices at T2 and T3 were elevated compared with those at T1. However, the levels of the indices at T4 were almost close to those at T0, and the levels in the study group were higher than those in the control group. There were statistically significant differences in the comparison of the interaction of the levels of the aforementioned indices between groups, between time points, and between groups and time points (P < 0.05). At 24 h after surgery, the