不同麻醉深度对结肠癌根治术老年患者术中葡萄糖和乳酸及术后早期认知功能的影响

Effects of different anesthesia depths on the glucose and lactate as well as the postoperative cognitive function in elderly patients undergoing supratentorial tumor resection.

目的研究不同麻醉深度对结肠癌根治术老年患者术中葡萄糖、乳酸及术后早期认知功能的影响。方法采用横断面研究的回顾性研究设计,选择海南省人民医院行结肠癌根治术的120例老年患者为研究对象,按照麻醉深度分为3组,脑电双频指数(BIS)监护仪监测麻醉深度,A组BIS指数30~39,B组BIS指数40~49,C组BIS指数50~59。诱导前(T1)、气管插管即刻(T2)、麻醉维持60 min(T3)、麻醉结束时(T4)、进入麻醉后监测治疗室(PACU)30 min(T5)时同步采集颈内静脉球部和桡动脉血测定血糖和乳酸含量,并计算出脑能量代谢指标为葡萄糖摄取率(GluER)和脑乳酸生成率(LacPR);并且术后第1、3、7天时,采用简易精神状态检查量表(MMSE)评价认知功能,另取3 mL静脉血应用酶联免疫吸附试验(ELISA)测定中枢神经特异蛋白(S100β)和神经元特异性烯醇化酶(NSE)水平。结果在GluER指标方面,A组和C组患者中,麻醉诱导后的各时间点(T2~T5)与T1相比均呈下降趋势,差异均有统计学意义(P<0.05);而B组患者在诱导前后,差异无统计学意义(P>0.05);在LacPR指标方面,B组患者在麻醉诱导后各节点(T2~T5)较T1逐渐降低,差异有统计学意义(P<0.05),而A组和C组在诱导前后,差异均无统计学意义(P>0.05)。术后第1、3、7天时,B组患者的MMSE评分较A组及C组均明显升高,而血清S100β蛋白及NSE水平明显降低,差异均有统计学意义(P<0.05)。结论BIS指数40~49的麻醉深度能够控制结肠癌根治术中老年患者的脑代谢,维持血糖平衡,降低LacPR,从而改善术后认知功能。

Objective To investigate the effects of different anesthesia depths on the glucose and lactate as well as the postoperative cognitive function in elderly patients undergoing supratentorial tumor resection.Methods Totally 120 elderly patients undergoing supratentorial tumor resection admitted to Hainan Provincial People's Hospital from February 2017 to June 2019 were selected and divided into the group A(n=40)with BIS index 30-39,the group B(n=40)with BIS index 40-49,the group C(n=40)with BIS index 50-59.Blood samples were taken from artery and jugular venous bulb simultaneously before induction of anesthesia(T1),intubation(T2),during separation(T3),at removal(T4),at the closure of dura(T5)cerebral lactate production rate(LacPR)and glucose extraction rate(GluER)were measured.1,3 and 7 d after surgery,mini-mental state examination(MMSE)was adopted to evaluate cognitive function,and the serum S100βand neuron-specific enolase(NSE)were measured.Results For A and C group,there were significant difference in the levels of GluER between T2,T3,T4 and T5 and T1,the differences were statistically significant(P<0.05),there was no significant difference in group B before and after induction(P>0.05).The levels of LacPR in group B gradually decreased between T2,T3,T4 and T5 and T1,and the difference was statistically significant(P<0.05),while group A and group C had no statistical difference before and after induction(P>0.05).1,3 and 7 days after surgery,the MMSE scores of group B were significantly higher than those of groups A and C,while the levels of serum S100βand NSE of group B were significantly lower than those of groups A and C,the differences were statistically significant(P<0.05).Conclusion The anesthesia depth with BIS index 40-49 can control cerebra metabolism in elderly patients undergoing supratentorial tumor resection,keep blood glucose balance,reduce LacPR and improve postoperative cognitive.