局部脑氧饱和度-脑电双频谱指数-目标导向血流动力学多模式对老年胸腔镜食管癌根治术患者术后谵妄的影响

The effect of regional cerebral oxygen saturation-bispectral index-goal-oriented hemodynamic multimode on postoperative delirium in elderly patients undergoing thoracoscopic radical resection of esophageal cancer

目的观察局部脑氧饱和度(r SO2)-脑电双频谱指数(BIS)-目标导向血流动力学多模式对老年胸腔镜食管癌根治术患者术后谵妄的影响。方法纳入2019年1月至2021年3月我院行择期全麻下胸腔镜食管癌根治术的老年患者80例,采用随机数字表法分为观察组与对照组各40例。对照组实施常规麻醉监测管理,观察组实施基于r SO2-BIS目标导向血流动力学多模式麻醉管理。比较两组术中情况,术中各时间点血流动力学参数,术后3 d内谵妄发生情况,术后并发症发生情况及术后恢复情况。结果两组手术时间、术中失血量、术中补液量、丙泊酚用量、瑞芬太尼用量比较,差异均无统计学意义(P>0.05);两组入室后、诱导后、插管即刻、插管后3 min、术中1 h、手术结束时平均动脉压(MAP)、心率(HR)比较,差异均无统计学意义(P>0.05);观察组术后3 d内谵妄总发生率低于对照组(P<0.05);两组术后并发症总发生率比较,差异无统计学意义(P>0.05);观察组术毕至呼之睁眼时间、术后住院时间均短于对照组(P<0.05)。结论老年胸腔镜食管癌根治术中实施基于r SO_2-BIS目标导向血流动力学多模式麻醉管理预防术后谵妄的发生,且有利于患者术后恢复。

Objective To observe the effect of regional cerebral oxygen saturation(r SO2)-bispectral index(BIS)-goaloriented hemodynamic multi-mode monitoring on postoperative delirium in elderly patients undergoing thoracoscopic radical resection of esophageal cancer.Methods Eighty elderly patients who underwent thoracoscopic radical esophagectomy under elective general anesthesia from January 2019 to March 2021 were involved in this study.The patients were randomly divided into an observation group and a control group,40 in each group.Routine anesthesia management was implemented in the control group,and multi-mode anesthesia management based on r SO2-BIS-goal-oriented hemodynamics was implemented in the observation group.The intraoperative conditions,hemodynamic parameters at each time point,delirium within 3 days after operation,postoperative complications,and postoperative recovery were compared between the two groups.Results There was no significant difference in operation time,intraoperative blood loss,intraoperative fluid replacement,propofol dosage,and remifentanil dosage between the two groups(P>0.05).There was no significant difference in mean arterial pressure(MAP)and heart rate(HR)between the two groups after entering operation room,after induction,immediately after intubation,3 min after intubation,1 h during operation and at the end of operation(P>0.05).The total incidence of delirium within 3 days after operation in the observation group was lower than that in the control group(P<0.05).There was no significant difference in the total incidence of postoperative complications between the two groups(P>0.05).The eye opening time and postoperative hospital stay in the observation group were shorter than those in the control group(P<0.05).Conclusion The implementation of anesthesia management based on r SO2-BIS-goal-oriented hemodynamic multi-mode during thoracoscopic radical resection of esophageal cancer in elderly patients can prevent the occurrence of postoperative delirium.It is also conducive to the recovery of patients after surgery.