麻醉深度脑电双频指数与老年腹部手术患者术后认知功能障碍的相关性研究

Correlation between bispectral index of depth of anesthesia and postoperative cognitive dysfunction in elderly patients with abdominal surgery

目的探讨麻醉深度脑电双频指数(bispectral index,BIS)与老年腹部手术患者术后认知功能障碍(postoperative cognitive dysfunction,POCD)的相关性。方法选取2021年9月至2022年8月永康市中医院收治的老年腹部手术患者100例作为研究对象,均行全凭静脉麻醉,根据麻醉深度不同分为D组(30≤BIS≤45,n=50)和L组(45≤BIS≤60,n=50)。观察两组围手术期血流动力学水平、术中用药情况及麻醉苏醒时间、疼痛情况、认知功能及POCD发生情况。结果D组有2例、L组有3例因手术时长>2h未纳入,最终D组纳入48例,L组纳入47例。两组围手术期不同时间平均动脉压(mean arterial pressure,MAP)水平比较,入室即刻(T0)、插管后即刻(T1)、手术开始(T2)、手术开始后30min(T3)、60min(T4)、术毕(T5)、拔管后即刻(T6)时间点,两组MAP水平呈先降低后升高趋势,T2~T6时间点L组MAP水平显著高于D组(P<0.05);两组心率比较,差异无统计学意义(P>0.05);D组术中丙泊酚用量显著多于L组,麻醉苏醒时间显著长于L组(P<0.05);D组术后6h、12h视觉模拟评分(visual analogue scale,VAS)显著低于L组低(P<0.05);L组术后1d的简易精神状态检查(mini mental status examination,MMSE)评分显著高于D组,连线实验(trail making test,TMT)时间显著低于D组(P<0.05),术前1d及术后3d、7d、1个月,两组MMSE评分和TMT时间比较,差异均无统计学意义(P>0.05);L组术后1d的POCD发生率显著低于D组(P<0.05),术后3d、7d、1个月两组POCD发生率比较,差异无统计学意义(P>0.05)。结论老年腹部手术患者术中麻醉深度BIS值控制在45~60范围内能稳定围手术期血流动力,缩短麻醉苏醒时间,改善术后早期(术后1d)认知功能和降低早期(术后1d)POCD发生风险。

Objective To investigate the correlation between the bispectral index(BIS)of the depth of anesthesia and postoperative cognitive dysfunction(POCD)in elderly patients with abdominal surgery.Methods A total of 100 elderly patients undergoing abdominal surgery in Yongkang Hospital of Traditional Chinese Medicine from September 2021 to August 2022 were selected as the research subjects,all of whom received total intravenous anesthesia,and were divided into groups D(30≤BIS≤45,n=50)and Group L(45≤BIS≤60,n=50).The perioperative hemodynamic levels,intraoperative medication,anesthesia recovery time,pain,cognitive function and the occurrence of POCD were observed in the two groups.Results Two cases in group D and three cases in group L were not included due to the duration of the operation>2h.48 cases were finally included in group D and 47 cases in group L.The mean arterial pressure(MAP)levels in the two groups were compared at different times during the perioperative period,with a decrease and then an increase trend in MAP levels at the time points immediately after admission(T0),immediately after intubation(T1),at the beginning of the procedure(T2),30 minutes after the start of the procedure(T3),60 minutes(T4),at the end of the procedure(T5)and immediately after extubation(T6).The MAP levels in group L were significantly higher than those in group D at time points T2 to T6(P<0.05),and there was no significant difference in heart rate levels between the two groups(P>0.05).The intraoperative dosage of propofol in group D was significantly higher than that in group L,and the recovery time from anesthesia was significantly longer than that in group L(P<0.05).The visual analogue scale(VAS)score of group D was significantly lower than that of group L at 6h and 12h after operation(P<0.05);the mini mental status examination(MMSE)score of group L was significantly higher than that of group D at 1 day after operation,and the trail making test(TMT)time was significantly shorter than that of group D(P<0.05).There was no statistically significant difference in MMSE score and TMT time between the two groups 1 day before and 3 days,7days and 1 month after surgery(P>0.05).The incidence of POCD in group L was significantly lower than that in group D at 1d after operation(P<0.05),and there was no significant difference in the incidence of POCD between the two groups at 3 days,7 days,and 1 month after operation(P>0.05).Conclusion Controlling the intraoperative BIS of the depth of anesthesia in elderly patients with abdominal surgery within the range of 45 to 60 can stabilize the perioperative hemodynamics,shorten the recovery time from anesthesia,improve cognitive function in the early postoperative period(1 day after operation),and reduce the early postoperative period(1 day after operation)risk of POCD.