脑状态指数监测对预防老年妇科患者术后认知功能障碍的作用

Cerebral state index monitoring prevents postoperative cognitive dysfunction in elderly patients undergoing gynecological surgery

目的：探讨脑状态指数（CSI）监测对预防老年妇科患者术后认知功能障碍（POCD）的作用。方法将60例择期老年妇科手术患者按随机数字表法分为两组，每组各30例，A组术中在CSI监测下调整丙泊酚剂量以维持CSI在40-60，B组由固定的高年资麻醉医师凭经验调控麻醉。记录诱导前（T1）、气管插管（T2）、切皮（T3）、手术标本切下（T4）、手术结束（T5）、回病房（T6）等各时点SpO2、MAP、HR值。记录两组患者异丙酚、顺苯磺酸阿曲库铵用量及麻黄碱、阿托品用药次数及麻醉恢复情况；并于麻醉前、应答后1、6h和1、3d采用简易精神状态量表（MMSE）评价认知功能。结果 A组MAP T4时点高于B组（P＜0.01），其余时点差异均无统计学意义（均P＞0.05）；A组异丙酚用量以及麻黄碱、阿托品用药次数均明显少于B组（均P＜0.01）；A组应答时间少于B组（P＜0.05）；两组患者应答后1h MMSE评分较麻醉前均下降，A组应答后6h时MMSE评分下降的幅度低于B组（P＜0.05），其余各时间段MMSE评分均属正常。结论 CSI可以作为老年妇科手术患者麻醉深度监测的一个重要指标，有利于减少POCD的发生。

Objective To investigate the effect of Cerebral State Index （CSI） monitoring on reducing the morbidity of postoperative cognitive dysfunction （POCD） in elderly patients with gynecological operation. Methods Sixty elderly patients scheduled for elective gynecological surgery were randomly divided into two groups with 30 in each group. Patients in group A were anesthetized by adjusting the doses of propofol to maintain CSI values in the range of 40 -60; patients in group B were anesthetized by the experienced anesthesiologists without monitoring CSI. The SpO2, MAP, HR values were recorded before in-duction （T1）, at endotracheal intubation （T2）, skin incision （T3）, surgical specimens cut （T4）, the end of surgery （T5） and back to the ward （T6）. The total dosages of propofol and atracurium cisatracurium, the frequencies of ephedrine and atropine administration and recovery time were observed and documented. The mini- mental state examination （MMSE） scores were used to assess the cognitive function at pre- anesthesia, and 1 h, 6 h, 1 d, 3 d after consciousness- recovered. Results The MAP of the group A was significantly higher than that of group B at T4（P〈0.01）, and there was no significant difference at other time point（P〉0.05）. The total dosages of propofol, and the frequencies of ephedrine and atropine administration were significantly decreased in the group A （P〈0.01）. The times of opening eyes and extubation were similar between two groups （P〉0.05）. Between two groups, MMSE score was significantly decreased 1h after recover of consciousness compared to the baseline score before anesthesia. At 6 h after recover of consciousness, the decrease of MMSE score in group A was less than that in group B （P〈0.05）. Conclu-sion CSI can be considered as a vital indicator for monitoring the depth of anesthesia, which is benefit for decreasing the inci-dence of POCD in elderly patients with gynecological surgery.