术中局部脑氧饱和度水平监测对老年肠梗阻术后短暂认知障碍的影响

Effect of Intraoperative Local Cerebral Oxygen Saturation Level Monitoring on Transient Cognitive Impairment after Intestinal Obstruction in the Elderly

目的探究与分析术中局部脑氧饱和度水平监测对老年肠梗阻术后短暂认知障碍的影响。方法按照随机数表法将2020年2月—2022年2月哈尔滨医科大学附属第二医院收治的120例因肠梗阻接受手术切除术治疗患者分为两组,各60例。对照组给予常规脑氧监测的方法进行干预,观察组在其基础上增加脑电双拼指数(bispectral index,BIS)监测进行干预。对比两组患者围术期的血清神经元特异性烯醇化酶(NSE)、中枢神经特异性蛋白(S100-β)蛋白水平,术前1 d、术后1 d及术后7 d的简易智力状态检查量表(MMSE)评分和蒙特利尔认知评估量表(MoCA)评分;对比两组患者术后短暂认知障碍的发生率。结果观察组术后的血清NSE水平及s100-β蛋白水平分别为(9.35±2.64)、(431.25±82.33)ng/mL,低于对照组,差异有统计学意义(t=3.448、2.076,P<0.05);观察组术后7 d的MMSE及MoCA量表评分分别为(24.79±2.05)分、(25.75±1.69)分,高于对照组,差异有统计学意义(t=3.354、4.281,P<0.05);观察组术后认知功能障碍发生率为1.67%(1/60),低于对照组的13.33%(8/60),差异有统计学意义(χ^(2)=4.324,P<0.05)。结论术中局部脑氧饱和度水平监测联合BIS应用在老年肠梗阻患者中可促进调节NSE及s100-β蛋白水平,减少对患者认知功能及智力状态带来的不良影响,降低术后短暂认知障碍的发生风险。

Objective To investigate and analyze the effect of intraoperative local cerebral oxygen saturation level monitoring on transient cognitive impairment after intestinal obstruction in the elderly.Methods According to the random number table method,120 patients treated by surgical resection for intestinal obstruction in the Second Affiliated Hospital of Harbin Medical University from February 2020 to February 2022 were divided into two groups,60 cases in each.The control group was given conventional cerebral oxygen monitoring for intervention,and the observation group was given additional EEG bipolar index(BIS)monitoring for intervention.Compared with the serum neuron-specific enolase(NSE),central nerve specific protein(s100-β)protein levels,the Mini-mental State Examination(MMSE)score and the Montreal Cognitive Assessment Scale(MoCA)score for preoperative 1 d,postoperative 1 d and postoperative 7 d;comparison of the incidence of postoperative transient cognitive impairment between two groups of patients Results The postoperative serum NSE level and s100-βprotein level in the observation group were(9.35±2.64)ng/mL and(431.25±82.33)ng/mL,respectively,lower than the control group,the difference was statistically significant(t=3.448,2.076,P<0.05);the MMSE and MoCA scale scores at postoperative 7 d of the observation group were(24.79±2.05)points and(25.75±1.69)points,respectively,higher than the control group,the difference was statistically significant(t=3.354,4.281,P<0.05);the incidence of postoperative cognitive dysfunction in the observation group was 1.67%(1/60),which was lower than 13.33%(8/60)in the control group,and the difference was statistically significant(χ^(2)=4.324,P<0.05).Conclusion Intraoperative local cerebral oxygen saturation level monitoring combined with BIS application in elderly patients with intestinal obstruction can promote the regulation of NSE and s100-βprotein levels,reduce the adverse effects on patients'cognitive function and intellectual status,and decrease the risk of postoperative transient cognitive impairment.