Narcotrend监测不同麻醉深度对老年肠癌患者术后早期认知功能障碍的影响

Effects of different depths of anesthesia on early postoperative cognitive dysfunction in elderly patients undergoing elective laparoscopic surgery for colorectal cancer

目的研究Narcotrend监测下三种不同麻醉深度对老年肠癌患者术后早期认知功能障碍(POCD)的影响。方法全身麻醉下行腹腔镜肠癌根治术的老年患者150例,年龄60～92岁,ASAⅠ～Ⅲ级,随机均分为三组,术中Narcotrend分级(NTS)分别维持在D0(A组)、D2(B组)或E1(C组)。记录麻醉诱导前(T0)、气管插管前(T1)、气管插管后即刻(T2)、气腹前2min(T3)、气腹后2min(T4)、手术结束(T5)、拔管时(T6)的HR、MAP。于术前1d和术后第7天对患者行认知功能评估,计算POCD发生率。结果与T0时比较,T2、T4～T6时A组HR明显增快(P<0.05),且明显快于B、C组(P<0.05);T1、T3时三组MAP均明显降低(P<0.05),且C组明显低于A、B组(P<0.05);T2、T4～T6时A组MAP明显升高(P<0.05),且明显高于B、C组(P<0.05)。145例纳入研究的患者中发生POCD的有38例(26.2%),其中A组有19例(39.6%),B组有8例(16.7%),C组有11例(22.4%),A组POCD发生率明显高于B、C组(P<0.05)。结论老年腹腔镜肠癌根治术中将NTS维持在D2或E1水平可降低术后早期POCD的发生率,且D2水平更有利于维持血流动力学的稳定。

Objective To investigate the effects of three different depths of anesthesia on early postoperative cognitive dysfunction（ POCD） in elderly patients undergoing elective laparoscopic surgery for colorectal cancer. Methods A total of 150 ASA I-lI patients aged 60-92 years undergoing elective laparoscopic surgery for colorectal cancer with general anesthesia were randomized into 3 groups, including group A ~anesthesia depth maintained with the target of Narcotrend stage （NTS） at Do level], group B（NTS at D2 level） and group C（NTS at E1 level）. HR and MAP values were recorded before anesthesia induction（T0 ）, before intubation （T1）, immediately after intubation（T2 ）, 2 minutes before pneumoperitoneum （Ta）, 2 minutes after pneumoperitoneum （T4）, at the end of surgery（Ts ） and at the time of extubation（T6 ）. The cognitive functions of the patients were evaluated 1 day before and 7 days after the surgery. Results HR at T2, T4-T6 in group A increased significantly compared to To, and they were also significantly higher than the HR at the same time point in groups B and C （P〈O. 05）. A significant decrease in MAP was observed at Tj and T3 in all three groups, with the value in group C significantly lower than those in groups A and B （P〈0. 05）. MAP increased significantly at T2 in group A （P〈0.05）, and were also significantly higher than the value at corresponding time points in groups B and C （P%0.05）. 38 out of 145 showed early POCD （26.2%）, with 19 in group A （39.6%）, 8 in group B （16.7%） and 11 in group C （22.4%）. The incidence of group A was significantly higher than that of groups B and C （P〈0. 05）. Conclusion Maintaining the depth of anesthesia at an NTS of I）2 level or E1 level could both reduce the incidence of early POCD in the elderly with laparoscopic surgery for colorectal cancer, but the 132 level is a better choice for hemodynamic stability.