摘要目的 比较丙泊酚全凭静脉麻醉与七氟醚静吸复合麻醉对老年女性患者术后睡眠质量的影响.方法 妇科腹腔镜手术患者120例,年龄65～80岁,BMI 18.5～25.0 kg∕m2,ASA分级Ⅰ-Ⅲ级,采取随机数字表法分为2组(n＝60):丙泊酚全凭静脉麻醉组(P组)和七氟醚静吸复合麻醉组(S组).麻醉诱导:静脉注射依托咪酯0.2～0.3 mg∕kg、舒芬太尼 0.2～0.4 μg∕kg 和顺阿曲库铵0.10～0.15 mg∕kg.麻醉维持:P组TCI丙泊酚血浆靶浓度2～4 μg∕ml,S组吸入1.2％～2.3％七氟醚;2组间断静脉注射舒芬太尼0.2～0.3 μg∕kg和顺阿曲库铵0.04～0.06 mg∕kg.分别于住院当天和手术当天、术后1、3、7、30 d的上午7-8时随访患者,记录匹兹堡睡眠质量指数(PSQI),PSQI>7分为发生睡眠障碍,记录睡眠障碍发生情况.于上述时点收集晨尿,采用ELISA法测定硫酸褪黑素及游离皮质醇浓度.结果 与S组比较,P组患者术后3和7 d时PSQI降低,术后7 d时睡眠障碍发生率降低,尿褪黑素浓度升高(P＜0.05),各时点尿游离皮质醇浓度差异无统计学意义(P>0.05).结论 丙泊酚全凭静脉麻醉对老年女性患者术后睡眠质量的影响较七氟醚静吸复合麻醉小.

abstractsObjective To compare the effect of total intravenous anesthesia with propofol and com-bined intravenous-inhalational anesthesia with sevoflurane on postoperative sleep quality in elderly female patients.Methods One hundred and twenty patients,aged 65-80 yr,with body mass index of 18.5-25.0 kg/m2,of American Society of Anesthesiologists physical status Ⅰ-Ⅲ,scheduled for elective gyne-cological laparoscopic operation,were divided into 2 groups(n＝60 each)by a random number table meth-od: total intravenous anesthesia with propofol group(group P)and combined intravenous-inhalational anes-thesia with sevoflurane group(group S).Anesthesia was induced with intravenous etomidate 0.2-0.3 mg/kg,sufentanil 0.2-0.4 μg/kg and cisatracurium 0.10-0.15 mg/kg.Anesthesia was maintained as fol-lows: propofol was given by target-controlled infusion with the target plasma concentration set at 2-4 μg/ml in group P,1.2-2.3％sevoflurane was inhaled in group S,and sufentanil 0.2-0.3 μg/kg and cisatracuri-um 0.04-0.06 mg/kg were intermittently injected in two groups.The patients were followed up at 7-8 a.m.on the day of hospitalization,the day of operation and 1,3,7 and 30 days after operation.The Pittsburgh Sleep Quality Index(PSQI)was recorded,PSQI> 7 points was considered as sleep disorders,and the oc-currence of sleep disorders was recorded.The morning urine was collected at the time points mentioned a-bove,and the concentrations of melatonin sulfate and free cortisol were determined by enzyme-linked immu-nosorbent assay.Results Compared with group S,the PSQI was significantly decreased on 3 and 7 days after operation,the incidence of sleep disorder was decreased on 7 days after operation,the concentrations of melatonin sulfate in urine were increased(P＜0.05),and no significant change was found in free cortisol in urine in group P(P>0.05).Conclusion The effect of total intravenous anesthesia with propofol on postoperative sleep quality is less than that of combined intravenous-inhalational anesthesia with sevoflurane in elderly female patients.