脑电双频指数监测对老年慢性贫血患者术后谵妄发生率的影响

The impact of bispectral index-guided anesthesia on the incidence of postoperative delirium in elderly patients with chronicanemia

目的 探讨BIS监测对老年慢性贫血患者腹部手术术后谵妄（postoperativedelirium，POD）发生率的影响。方法180例择期行全身麻醉手术患者，按随机数字表法分为两组（每组90例）：BIS监测组及对照组，对照组采用常规麻醉，BIS监测组维持BIS值于40～60。记录患者入室后（T0）、诱导后（TJ）、插管即刻（T2）、插管后3min（T3）、切皮（T4）、术中1h（T5）及手术结束（T6）各时间点的血流动力学指标。观察记录患者麻醉期间丙泊酚用量、手术时间、拔管时间、清醒时间，及POD发生情况。结果BIS监测组谵妄总发生率17．8％，低于对照组的31．1％（P〈0．05）；其中，BIS监测组谵妄第1天发生率13．3％，明显低于对照组的28．9％（P〈0．05），第2天发生率5．6％，低于对照组的14．4％（P〈0．05）；BIS监测组谵妄持续时间明显低于对照组（P〈0．05）。BIS监测组术后清醒拔管时间[（26±8）min]及住院时间[（11．5±2．3）d]显著短于对照组[（41±12）min、（12．6±4．4）d]（P〈0．05o结论BIS监测下麻醉可降低老年合并慢性贫血患者POD发生率，减少谵妄持续时间。

Objective Discuss the influence of BIS monitoring on the incidence of postoperative delirium （POD） in elderly patients with chronic anemia. Methods One hundred and eighty cases of elective surgery under general anesthesia were randomly divided into BIS monitoring group and control group （n=90）, the control group using routine anesthesia, and BIS monitoring group maintaining the value of BIS between 40-60 during anesthesia. The hemodynamic indexes were monitored after entering the operation room（T0）, after anesthesia（T1）, immediate intubation（T2）, 3 min after intubation（T3）, cut the skin（T4）, 1 h during operation（Ts）, the end of operation（T6）. Observe the dose of propofol during anesthesia, surgery time, extubation time, recovery time and the occurrence of POD in patients. Results The overall incidence of BIS monitoring group delirium was 17.5%, lower than 31.2% in the control group （P〈0.05）, the incidence of delirium on the first day of 13.3% was significantly lower than 28.9% in the control group （P〈0.05）, the incidence of 5.6% in the second day also lower than 14.4% in the control group （P〈0.05）, and duration of delirium was significantly lower than the control group （P〈0.05）. The extubation time [（26~8） mini and hospital stays [（11.5~2.3） d] of BIS monitoring group were significantly earlier than [（41±12） min and （12.6±4.4） d] control group, the difference was statistically significant （P〈0.05）. Conclusions BIS monitored anesthesia reduces the incidence of POD and reduces the duration of delirium in elderly patients with chronic anemia.