围麻醉期脑氧饱和度联合BIS监测对老年肠梗阻患者术后谵妄的影响

The effect of Peri-Anesthesia Cerebral Oxygen Saturation Combined with BIS Monitoring on Postoperative Delirium in Elderly Patients with Intestinal Obstruction

目的评价围麻醉期脑氧饱和度联合BIS监测对老年肠梗阻患者术后谵妄的影响。方法选择急诊因肠梗阻行肠切除的老年患者60例,年龄60~80岁,采用随机数字表法将患者分为脑血氧饱和度联合BIS监测组(BS组)及对照组(C组),每组30例。BS组患者同时使用脑氧饱和度联合BIS监测,根据两者数值作为麻醉用药管理依据,脑氧饱和度监测从麻醉诱导前开始至患者出复苏室。围麻醉期脑氧饱和度绝对值不低于50%,下降不低于术前吸纯氧时脑氧饱和度值的80%,BIS值维持在40~60之间。C组脑氧饱和度值与BIS值仅记录,不作为麻醉管理依据。收集所有患者的一般资料及术中相关情况。记录入室后、插管即刻、切皮时、麻醉后1 h及术毕时血流动力学指标。记录患者术后1~7 d谵妄及不良反应发生情况。结果与C组相比,BS组患者术中丙泊酚用量显著降低(P<0.05),两组患者术中其他情况比较差异无统计学意义(P>0.05)。C组患者术后第1及2天谵妄发生率显著高于BS组,两组差异有统计学意义(P<0.05)。与C组相比,BS组患者1周内谵妄总的发生率显著降低(P<0.05)。在不良反应方面,BS组患者术后恶心呕吐的发生率显著低于C组(P<0.05),两组患者在其他不良反应方面及术后住院时间差异无统计学意义(P>0.05)。结论围麻醉期脑血氧饱和度联合BIS监测能降低急诊肠梗阻老年患者术后谵妄发生率,减少患者术后恶心呕吐的发生,有利于患者术后恢复。

Objective To evaluate the effects of peri-anaesthesia cerebral oxygen saturation combined with BIS monitoring on postoperative delirium in elderly patients with intestinal obstruction.Methods Sixty elderly patients aged 60 years and older,who underwent bowel resection due to intestinal obstruction in our hospital from March 2018 to November 2019,were selected.The patients were divided into two groups by random number table method,cerebral oxygen saturation combined with BIS monitoring group(Group BS group)and control group(Group C).Patients in the Group BS used both cerebral oxygen saturation and BIS monitoring at the same time.The monitoring of cerebral oxygen saturation started from before anesthesia induction and ended after extubation.During the anesthesia period,the absolute value of cerebral oxygen saturation was not less than 50%,and the decline not less than 80%of the value of cerebral oxygen saturation during pure oxygen inhalation before surgery,and the BIS value is maintained between 40-60.The cerebral oxygen saturation value and BIS value of Group C were recorded only,and were not used as the basis for anesthesia management.General information and intraoperative information of all patients were collected.Hemodynamic indexes were recorded after admission,immediately after intubation,at the time of skin incision,1 hour after anesthesia,and at the end of the operation.Delirium and adverse reactions of patients 1-7 days after operation were recorded.Results There was no significant difference in general information and intraoperative hemodynamic indexes between the two groups(P>0.05).Compared with Group C,the amount of propofol used in Group BS was significantly reduced(P<0.05),and there was no significant difference in other conditions between the two groups(P>0.05).The incidence of delirium on Day 1,2,3 and 4 after operation in Group C was significantly higher than that in Group BS(P<0.05).Compared with Group C,the overall incidence of delirium in patients in Group BS was significantly reduced within one week(P<0.05).In terms of adverse reactions,the incidence of postoperative nausea and vomiting was significantly lower in Group BS than in Group C(P<0.05).There were no significant differences in other adverse reactions and postoperative hospital stay between the two groups(P>0.05).Conclusion Peri-anaesthesia cerebral blood oxygen saturation combined with BIS monitoring can reduce the incidence of delirium in elderly patients with emergency intestinal obstruction,reduce the incidence of postoperative nausea and vomiting,and help patients recover.