Narcotrend监测下麻醉深度对老年患者胃肠道肿瘤手术后认知功能障碍的影响

Effect of anesthesia depth with Narcotrend monitoring on cognitive function after gastrointestinal tumor surgery in elderly patients

目的:探讨镇静深度监测系统Narcotrend(NT)监测下麻醉深度与局部脑氧饱和度(regional cerebral oxygen saturation, rSO2)的相关性,及其在预测老年胃肠道肿瘤患者术后认知功能障碍(post-operative cognitive dysfunction, POCD)的价值。方法:按照纳入标准择取2018年6月~2019年6月在安徽医科大学附属安庆医院行胃肠道肿瘤择期手术的老年患者90名,患者术中行NT监测麻醉深度,采用近红外光谱仪持续监测rSO2。分别采集患者术前1 d、手术结束时和术后24 h的外周血,ELISA法检测血浆中S100β和白细胞介素6(interleukin-6, IL-6)的表达变化。采用简易智力状况检测法(mini-mental state examination, MMSE)评估患者术后24 h的认知功能。结果:术后24 h共有25例患者被诊断为POCD,POCD患者术中Narcotrend指数(Narcotrend index, NTI)<35的时间显著高于非POCD组(P<0.05)。POCD患者术中ΔrSO2>13%和rSO2<55%的时间均显著高于非POCD组,术中NTI<35的时间与ΔrSO2>13%时间具有显著相关性(r=0.62,95%CI=0.35~0.89,P=0.004)。POCD患者外周血中S100β浓度显著高于非POCD组(P<0.05),但两组之间IL-6含量无明显差异。结论:深麻醉可能加剧老年患者术中脑内氧供需失衡,进而造成中枢神经系统的损伤。Narcotrend监测下合理调控麻醉深度可能有助于预防术后认知功能障碍的发生。

AIM: To determine the correlation of anesthesia depth and the regional cerebral oxygen saturation(rSO2) under the monitoring of Narcotrend(NT), and its predictive value for post-operative cognitive dysfunction(POCD) in senior patients undergoing gastrointestinal tumor surgery. METHODS: From June 2018 to June 2019, 90 elderly patients who were scheduled for gastrointestinal tumor surgery were enrolled. The depth of anesthesia was monitored with Narcotrend index(NTI), and the rSO2 was evaluated by the near-infrared spectroscopy throughout the intraoperative periods. Cognitive function of the patients was evaluated by using mini-mental state examination(MMSE) 24 h after surgery. RESULTS: The patients(n=25) were diagnosed with POCD at 24 h after surgery. The patients with POCD had significantly longer duration of NTI<35 than that in non-POCD patients(P<0.05). Moreover, there was significantly longer duration of ΔrSO2>13% to baseline and rSO2<55%. The duration of NTI<35 was highly correlated with the duration of ΔrSO2>13% to baseline(r=0.62, 95% CI=0.35~0.89, P=0.004). The serum S100β level in POCD group was significantly higher than that in non-POCD patients, while there was no statistically difference with respect to the serum level of interleukin-6(IL-6). CONCLUSION: Deep anesthesia was likely to exacerbate the imbalance of cerebral oxygen supply and consumption in elderly surgical patients, which might further cause the injury of central nervous system. Narcotrend-guided anesthesia might have beneficial effects on the prevention of POCD especially in elderly patients.