意识指数监测不同麻醉深度对肠癌患者围术期应激反应、免疫功能及认知功能的影响

Effect of Consciousness Index Monitoring of Different Anesthesia Depth on Perioperative Stress Response,Immune Function and Cognitive Function in Patients with Bowel Cancer

目的:探讨意识指数(IoC)监测不同麻醉深度对肠癌患者围术期应激反应、免疫功能及认知功能的影响。方法:选取我院拟行全身麻醉腹腔镜肠癌根治术患者115例,随机分为A、B、C、D、E组,每组23例,术中均监测IoC指数,使A组麻醉深度维持在D0级、B组在D1级、C组在D2级、D组在E0级、E组在E1级。比较5组患者围术期的应激反应、免疫功能及认知功能。结果:A、B组术毕、术后1d的血清皮质醇(Cor)水平明显上升(P<0.05),且明显高于C、D、E组(P<0.05);C、D、E组术毕、术后1d的血清内皮素1(ET-1)水平明显下降(P<0.05),且明显低于A、B组(P<0.05)。D、E组术毕、术后1d的CD3^+、CD4^+及NK水平明显明显下降(P<0.05),且明显低于A、B、C组(P<0.05)。A、B组词语流畅性测验结果明显下降(P<0.05),且明显低于C、D、E组(P<0.05);C、D、E组简易智力状态检查量表(MMSE)结果明显上升(P<0.05),且明显高于A、B组(P<0.05)。结论:在IoC监测下维持麻醉深度为D2水平既能显著降低肠癌患者围术期应激程度,还可有效减少对患者免疫功能及认知功能的影响,值得临床推广应用。

Objective:To investigate the effect of consciousness index(IoC)monitoring of different anesthesia depth on perioperative stress response,immune function and cognitive function in patients with bowel cancer.Methods:A total of 115 patients undergoing laparoscopic radical colonectomy for general anesthesia in our hospital were randomly divided into groups A,B,C,D,and E,with 23 in each group.All patients were monitored for IoC index during operation to maintain the depth of anesthesia in group A at D0,group B at D1,group C at D2,group D at E0,and group E at E1.The perioperative stress response,immune function and cognitive function of the five groups were compared.Results:Serum cortisol(Cor)levels in group A and B increased significantly after operation and 1 day after operation(P<0.05),and were significantly higher than those in groups C,D,and E(P<0.05).The serum endothelin-1(ET-1)level decreased significantly at the end of 1 day and postoperatively(P<0.05),and was significantly lower than that of the A and B groups(P<0.05).The levels of CD3^+,CD4^+ and NK in group D and E were significantly decreased after operation and 1 day after operation(P<0.05),and were significantly lower than those in groups A,B,and C(P<0.05).The fluency test results of groups A and B decreased significantly(P<0.05),and were significantly lower than those of groups C,D,and E(P<0.05);the results of the simple mental state examination scale(MMSE)of groups C,D,and E were significant increased(P<0.05),and was significantly higher than those in groups A and B(P<0.05).Conclusion:Maintaining anesthesia depth to D2 level under IoC monitoring can not only significantly reduce the perioperative stress of patients with bowel cancer,but also effectively reduce the impact on patients’immune and cognitive functions,which is worthy of clinical application.