脑氧饱和度监测目标导向管理对老年全麻下腹腔镜结直肠癌根治术后早期认知功能的影响

Effect of target-oriented management of regional cerebral oxygen saturation monitoring on early cognitive function in the elderly after laparoscopic radical resection of colorectal cancer under general anesthesia

目的探究脑氧饱和度(rScO_(2))监测目标导向管理对老年全麻下腹腔镜结直肠癌根治术后早期认知功能的影响。方法选取江苏省苏州市第九人民医院2020年1月至2021年12月收治的92例老年结直肠癌患者作为研究对象,采用随机数字表法将其分为对照组和研究组,每组46例。对照组实施常规麻醉监测管理,研究组在对照组基础上联合rScO_(2)监测。比较两组术前及术后24 h认知功能;比较两组患者术前(T_(0))、麻醉后30 min(T_(1))、拔管后5 min(T_(2))心率、平均动脉压(MAP)、乳酸水平及体温;比较两组术后24 h镇痛情况;记录两组围手术期不良反应发生情况。结果术后24 h,两组简易智力状态检查量表评分较术前降低,研究组高于对照组,差异有统计学意义(P<0.05)。T_(2)时,研究组心率低于T_(0)及T_(1)时;MAP、乳酸高于T_(0)及T_(1)时,差异有统计学意义(P<0.05)。T_(1)时,研究组心率低于T_(0)时;乳酸高于T_(0)时,差异有统计学意义(P<0.05)。T_(2)时,对照组心率、MAP低于T_(0)时;乳酸高于T_(0)及T_(1)时,差异有统计学意义(P<0.05)。T_(1)时,对照组心率低于T_(0)时;MAP、乳酸高于T_(0)时,差异有统计学意义(P<0.05)。T_(2)时,研究组乳酸低于对照组,差异有统计学意义(P<0.05);T_(1)时,研究组MAP高于对照组,乳酸低于对照组,差异有统计学意义(P<0.05)。两组不同时间点体温比较,差异无统计学意义(P>0.05)。两组术后24 h镇痛效果比较,差异无统计学意义(P>0.05)。两组围手术期不良反应总发生率比较,差异无统计学意义(P>0.05)。结论rScO_(2)监测目标导向管理应用于老年结直肠癌患者全麻下结直肠癌根治术中,有助于降低患者术后认知功能障碍风险。

Objective To explore the effect of target-oriented management of regional cerebral oxygen saturation(rScO_(2))monitoring on early cognitive function in the elderly after laparoscopic radical resection of colorectal cancer under general anesthesia.Methods Ninety-two elderly patients with colorectal cancer admitted to Suzhou Ninth People's Hospital,Jiangsu Province,from January 2020 to December 2021 were selected as research objects.They were divided into control group and study group,with 46 cases in each group.The control group received routine anesthesia monitoring management,and study group was combined with rScO_(2) monitoring on the basis of control group.The cognitive function of two groups before operation and 24 h after operation were compared;heart rate,mean arterial pressure(MAP),lactate level,and body temperature were compared before operation(T_(0)),30 min after anesthesia(T_(1))and 5 min after extubation(T_(2));24 h postoperative analgesia was compared between two groups;the occurrence of perioperative adverse reactions was recorded in two groups.Results The scores of mini-mental state examination scale 24 h after operation in two groups were lower than those before operation,and study group was higher than control group,and the differences were statistically significant(P<0.05).At T_(2),heart rate of study group was lower than that at T_(0) and T_(1);MAP and lactic acid were higher than those at T_(0) and T_(1),and the differences were statistically significant(P<0.05).At T_(1),heart rate of study group was lower than that that at T_(0);lactic acid was higher than that at T_(0),and the differences were statistically significant(P<0.05).At T_(2),heart rate and MAP of control group was lower than that at T_(0);lactic acid were higher than those at T_(0) and T_(1),and the differences were statistically significant(P<0.05).At T_(1),heart rate of control group was lower than that at T_(0),MAP and lactic acid were higher than those at T_(0),and the differences were statistically significant(P<0.05).At T_(2),lactic acid in study group was lower than that in control group,and the difference was statistically significant(P<0.05);at T_(1),MAP of study group was higher than that of control group,and lactic acid was lower than that of control group,and the differences were statistically significant(P<0.05).There was no significant difference in body temperature between two groups at different time points(P>0.05).There was no significant difference in 24 h postoperative analgesic effect between two groups(P>0.05).There was no significant difference in the total incidence of perioperative adverse reactions between two groups(P>0.05).Conclusion Target-oriented management of rScO_(2) monitoring should be used in radical resection of colorectal cancer in elderly patients under general anesthesia to help reduce the risk of postoperative cognitive dysfunction in patients.