不同麻醉深度对硬膜外联合全身麻醉老年患者下腹部手术早期术后认知功能障碍的影响

Effects of Different Depths of Epidural Combined General Anesthesia with Narcotrend Monito- ring on POCD of Elderly Patients Who Undergo Lower Abdominal Surgery

【目的】探讨不同麻醉深度对硬膜外联合全麻老年患者下腹部手术早期术后认知功能障碍（POCD）、术中知晓、血流动力学的影响。【方法】选择本院拟择期硬膜外联合全身麻醉下行下腹部手术、ASAⅡ～Ⅲ级的老年患者40例，随机分为两组，每组20例，应用麻醉深度监测仪（Narcotrend）行麻醉深度监测。深麻醉组（A组）：Narcotrend指数（narcotrend index，NI）测值维持在36～49，即E0D1分级；浅麻醉组（B组）：NI实测值维持在50～64，即D1-D0级）。记录两组各时间点的IN值和血压、心率、苏醒时间、拔管时间、血管活性药物的应用情况和简易智能量表（MMSE）、POCD、术后恶心呕吐以及术中知晓的发生率。【结果】两组患者均未发生术中知晓，其中共有8例（20％）发生POCD，A组为5例（25％），B组3（15％）例，A组POcD发生率高于B组，但两组的差异无统计学意义（P〉0．05）。B组苏醒时间（8±2．7）min及拔管时间（9±2．2）min均较A组苏醒时间（18±3．4）min及拔管时间（20±4．1）rain短，差异有统计学意义（P〈0．05）。B组术中血压均值（103±13）1TimHg较A组术中血压均值（89±8．7）mmHg更平稳、B组麻黄碱使用率（5％）明显低于A组麻黄碱使用率6（30％），差异有统计学意义（P〈0．05）。【结论】硬膜外联合全身麻醉老年患者下腹部手术后浅麻醉较深麻醉组术中血流动力学更平稳，而POCD的发生率无明显差异。

[Objective[To evaluate the effects of different depths of Epidural combined general anesthesia with Narcotrend monitoring on elderly patients who undergo lower abdominal surgery. [Methods]Forty patients ages〉65 and ASA Ⅱ ~ Ⅲ who undergo lower abdominal surgery were randomly divided into 2 groups： Group A （deep anesthesia） and Group B（light anesthesia）. The patients＇ NI （narcotrend index）, BP （ blood Pressure）, HR（hear rate）,time to revive,time to extubation, dosage of vasoactive drugs, MMSE,POCD, postoperative nausea and vomiting,and intraoperative awareness were all recorded. [Results]No patients in either of the two groups had intraoperative awareness. Incidence of POCD was： Group A had 5 eases（25%）and Group B had 3 cases（15%）. The incidence of POCD in Group B was lower than in Group A, but two groups did not have any significant difference（ P 〉0.05）. Time to revive（8±2.7）min and time to extubation（9±2.2） rain in Group 13 was shorter than Group A, and significant differences were observed between the two groups （ P 〈0.05）. The incidence of hypotension, dosage of vasoactive drugs in Group B lower than Group A, and significant differences were observed between the two groups （ P 〈0.05）. [Conclusion]Different anesthesia depths of Epidural combined general anesthesia on elderly patients who undergo lower abdominal surgery have no difference on the incidence of POCD, but hemodynamics of shallow anesthesia is more stable.