脑氧饱和度监测下对老年患者腹腔镜手术术后认知功能障碍的影响

The effect of brain oxygen saturation monitoring on cognitive dysfunction after abdominal endoscopic surgery in elderly patients

目的探讨不同脑氧饱和度数值监测下对腹腔镜手术老年患者术后认知功能的影响。方法选择2018年10月-2019年6月就诊于本院的择期手术老年患者90例作为研究对象,随机分为实验组(A组、B组)和对照组(C组)共3组,每组各30例。A组局部脑氧饱和度(rScO2)为60%~70%,B组rScO2为71%~80%。检测患者术前、术中、术后神经元特异性烯醇化酶(NSE)、S100β蛋白浓度,及术前、术后1 d、术后7 d简易智力状态检查量表(MMSE)、蒙特利尔认知评估量表评分(MoCA),观察三组患者术后认知功能障碍(POCD)的发生情况,探讨其影响。结果 A、B两组术中及术后NSE、S100β蛋白浓度低于C组,差异有统计学意义(P<0.05)。A、B两组术后1 d及术后7 d MMSE、MoCA评分高于C组,差异有统计学意义(P<0.05)。与C组比较,A、B组术后机械通气时间、麻醉后监测治疗室(PACU)留观时间缩短,但差异无统计学意义(P>0.05)。结论老年患者手术术中rScO2降低可能诱发POCD,术中维持rScO2在一定范围内可降低POCD的发生,术中rScO2的下降与POCD的发生两者之间有关联性,监测rScO2具有重要的临床意义。

Objective To investigate the influence of different brain oxygen saturation monitoring on the incidence of cognitive dysfunction in elderly patients undergoing abdominal endoscopic surgery.Methods 90 cases of elderly patients would receive surgical procedures,admitted to our hospital during October 2018 and June 2019,were randomly divided into three groups: experimental group(group A and group B) and control group(group C),with 30 cases in each group.Local cerebral oxygen saturation(rScO2) in group A and group B were 60% ~70%,and 71% ~ 80%,respectively.Preoperative,intraoperative and postoperative NSE,and concentration of S100β protein in both groups were detected.Scores of Mini-mental State Examination(MMSE),Montreal Cognitive Assessment(MoCA) were measured on the before surgery,one day after operation,and seven days after surgical treatment to assess the incidence of postoperative cognitive disturb and its influence factors.Results Intrao perative and postoperative NSE and S100 beta protein in group A and group B was lower than that in group C,and the difference was statistically significant(P<0.05).MMSE and MoCA score in group A and group B was higher than that in group C on the first day and seventh day after surgery,with statistically significant difference(P<0.05).Compared with group C,mechanical ventilation time and PACU duration in group A and B was shortened,but the difference was not statistically significant(P>0.05).Conclusions These results suggest that the decrease of rSO2 during surgery may induce POCD in elderly patients,and intraoperative maintenance of rSO2 could reduce POCD to a certain extent.There is a correlation between the decrease of rSO2 during surgery and POCD,so monitoring rSO2 is of great clinical significance.