老年人不同脑电双频谱指数下全麻择期腹部手术后认知功能及S100β蛋白浓度观察

Cognitive function and S100 beta protein concentration in elderly patients after elective abdominal surgery by general anaesthesia according to different EEG bispectral indexes

目的探究不同脑电双频谱指数下全麻行择期腹部手术老年患者术后认知功能及S100β蛋白水平的应用。方法选择2016年3月至2018年2月拟行全麻行择期腹部手术老年患者72例,随机数法分为A组、B组和C组,每组24例。在采用丙泊酚靶控输注复合瑞芬太尼麻醉方案的基础上,分别应用BIS值为30～39,40～49和50～59 3个范围控制麻醉深度。比较3组患者丙泊酚和瑞芬太尼用量,2组麻醉期间血流动力学指标、术中不良反应情况、术后认知功能和术后认知障碍的发生率及S100β蛋白浓度。结果 3组患者手术时间、丙泊酚和瑞芬太尼用量以及苏醒时间均差异无统计学意义(F=1.195,1.924,0.358,1.807,P=0.309,0.154,0.700,0.172)。与T0时刻比较,3组患者T1时刻的HR、MAP均出现明显降低(P<0.05),其中,A组患者HR和MAP均显著高于B组和C组(P<0.05);与T0和T4时刻比较,B组和C组T2、T3时刻的HR和MAP均明显升高(P<0.05),且均明显高于A组(P<0.05),而A组T2、T3、T4时刻的HR和MAP差异无统计学意义(P>0.05)。A、B、C组术中分别发生循环不良反应3例、3例和4例,差异无统计学意义(χ~2=2.232,P=0.890)。与术前比较,3组患者术后2 h和24 h MMSE评分均显著低于术前(P<0.05),其中,B组和C组术后2 h和24 h MMSE评分明显低于A组(P<0.05)。B组和C组分别发生POCD 15例和16例,2组POCD发生率明显高于A组(χ~2=4.090,5.333;P=0.043,0.021)。3组患者术毕、术后24 h和48 h的血清S100β蛋白水平均明显高于术前(P<0.05),其中,B组和C组显著高于A组(P<0.05)。结论老年患者在BIS值30～39下行全麻择期腹部手术,循环指标较为平稳,对术后认知功能及S100β蛋白水平干扰较小。

Objective To explore the cognitive function and S100 beta protein concentration in elderly patients after elective abdominal surgery by general anaesthesia according to different EEG bispectral indexes. Methods Seventy-two elderly patients who underwent general anesthesia for elective abdominal surgery in our hospital from March 2016 to February 2018 were randomly divided into group A ( n =24), group, B ( n =24) and group C ( n =24). Based on propofol target controlled infusion combined with remifentanil anesthesia protocol, BIS values ranging from 30 to 39, 40 to 49 and 50 to 59 were used to control the depth of anesthesia in the three groups, respectively. The doses of propofol and remifentanil,hemodynamics, intraoperative adverse reactions, postoperative cognitive function and postoperative cognitive impairmentafter surgury and S100β protein concentration were compared between the three groups. Results There were no significant differences in operative time, recovery time and dosages of propofol and remifentanil among the three groups ( F =1.195, 1.924 , 0.358, 1.807, P >0.05).As compared with those at T0, the levels of HR and MAP at T1 in the three groups were significantly reduced ( P <0.05), in which, the HR and MAP in group A were significantly higher than those in group B and group C (P<0.05). As compared with those at T0 and T4, the HR and MAP at T2 and T3 in group B and group C were significantly increased,which were significantly higher than those in group A ( P <0.05). Whereas, there were no significant differences in the levels of HR and MAP at T2, T3 and T 4 in group A ( P >0.05). Moreover, there were 3 cases, 3 cases and 4 cases of circulatory adverse reaction during surgery in group A, group B and group C, respectively. No significant difference was found among the three groups (χ^ 2=2.232, P >0.05). Furthermore, as compared with those before operation, the MMSE scores at 2h and 24h in the three groups were significantly lower than those before operation ( P <0.05), in which the scores in group B and group C were significantly lower than those in group A ( P <0.05). 15 cases and 16 cases of POCD were observed in group B and group C, which indicated the higher incidence in group B and group C (χ^ 2=4.090, 5.333,respectively, P <0.05). In addition, the serum levels of S100 and beta protein of the patients at the end of operation, 24h and 48h after operation in the three groups were significantly higher than those before operation ( P <0.05), in which those in group B and group C were significantly higher than those in group A ( P <0.05). Conclusion The indexes of circulation are more stable in elderly patients undergoing elective abdominal surgery under BIS30~39, with little disturbance to cognitive function after operation and the level of S100 beta protein.