多模式麻醉监测管理在脆弱脑功能老年胃肠肿瘤患者的应用

The application of multi-mode anesthesia monitoring and management in the operation of elderly patients with gastrointestinal tumor and fragile brain function

目的观察多模式麻醉监测管理在脆弱脑功能老年胃肠肿瘤患者的术中应用效果。方法择期全凭静脉麻醉下胃肠肿瘤手术的脆弱脑功能患者109例,按随机双盲法分为观察组(58例)和对照组(51例)。对照组术中接受常规麻醉监测管理,观察组术中接受多模式麻醉监测管理,包括监测心脏指数(cardiac index,CI),每搏输出量变异度(stroke volume variation,SVV)、BIS、四个成串刺激(train-of-four stimulation,TOF)及局部脑氧饱和度(regional cerebral oxygen saturation,rScO2)等。观察并比较两组下列指标:①术中相关麻醉药物的使用量;②术后10 min、1h、6 h、24 h、48 h、72 h的Ramsay镇静评分与VAS评分;③入室时(T0)、输注负荷量右美托咪定后(T1)、插管后1 min(T2)、切皮后(T3)、术毕(T4)、拔管后1 min(T5)的心率与MAP;④术后恢复情况相关指标(术毕至呼之睁眼时间、术毕至拔管时间、PACU驻留时间、胃肠功能恢复时间及住院时间);⑤术后谵妄(postoperative delirium,POD)与术后认知功能障碍(postoperative cognitive dysfunction,POCD)的发生情况。结果观察组丙泊酚与顺苯磺酸阿曲库铵术中使用量小于对照组(P<0.05),术后1、6、24、72 h Ramsay镇静评分高于对照组(P<0.05),术后10 min、1 h、6 h、24 h、48 h VAS评分低于对照组(P<0.05),T1~T5时的心率与T2~T5时的MAP低于对照组(P<0.05),观察组心率于T1时较T0时降低(P<0.05),对照组T2,T3,T53个时点的心率高于T0(P<0.05),对照组T2、T3、T43个时点的MAP高于T0(P<0.05);观察组术毕至呼之睁眼时间、术毕至拔管时间、PACU驻留时间、住院时间均短于对照组(P<0.05),术后72 h内总计POD发生率低于对照组(P<0.05)。结论多模式麻醉监测管理在脆弱脑功能老年胃肠肿瘤患者的术中应用效果满意。

Objective To observe the effect of multimode anesthesia monitoring and management in the operation of elderly patients with gastrointestinal tumor and fragile brain function.Methods One hundred and nine cases of patients with fragile brain function who underwent elective total intravenous anesthesia for gastrointestinal tumor surgery were divided into observation group(58 cases)and control group(51 cases).The control group received routine anesthesia monitoring management during operation,while the observation group received multi-mode anesthesia monitoring management during operation,including cardiac inde(CI),stroke volume variation(SVV),bispectral index(BIS),train-of-four stimulation(TOF)and regional cerebral oxygen saturation(rScO2).The following indexes were observed and compared between the two groups:①Intraoperative dosage of related anesthetics.②Ramsay sedation score and Visual Analogue Scale(VAS)score at 10 min and 1 h,6 h,24 h,48 h,72 h after operation.③Heart rate(HR)and mean artery pressure(MAP)at admission(T0),infusion load of dexmedetomidine(T1),1 min after intubation(T2),after skin incision(T3),after operation(T4),1min after extubation(T5).④Postoperative recovery,the relevant indicators are the opening time from the end of operation to the call,the time from the end of operation to extubation,the time of postanesthesia care unit(PACU)residence,the time of gastrointestinal function recovery and hospitalization.⑤Postoperative delirium(POD)and the occurrence of postoperative cognitive dysfunction(POCD).Results The dosage used of propofol and cisatracurium besylate in the observation group were significantly less than the dosage used in control group(P<0.05).The postoperative Ramsay sedation scores of observation group at 1,6,24,72 h were significantly higher than the score of the control group(P<0.05),the postoperative VAS at 10 min,1 h,6 h,24 h,48 h were significantly lower than the control group(P<0.05).The HR at T1-T5 time and MAP at T2-T5 time of observation group were significantly lower than the HR and MAP of control group(P<0.05).Postoperative observation group and called the open end of the operation time,extubation time,PACU dwell time and hospitalization time were significantly shorter than the values of control group(P<0.05).The total POD incidence rate in patients of the observation group in were significantly lower than the rate of the control group(P<0.05).Conclusions The application of multi-mode anesthesia monitoring and management in the operation of elderly patients with gastrointestinal cancer and fragile brain function is satisfactory.