脑电双频指数监测下全身麻醉对老年口腔癌根治术病人术后谵妄的影响

Influence of general anesthesia guided by bispectral index monitoring on postoperative delirium in elderly patients undergoing radical resection of oral cancer

目的:采用脑电双频指数(BIS)监测全身麻醉术中麻醉深度,探讨BIS监测对老年口腔癌根治术病人术后谵妄(POD)发生率及皮瓣存活率的影响。方法:68例全麻下行口腔癌皮瓣转移修复术病人随机分为2组,年龄65~80岁,ASAⅠ~Ⅲ级,BIS组(n=34)在全麻中调节BIS值在45~60之间,非BIS组(n=34)术中不使用BIS监测。术后第1天、第5天使用意识模糊评估量表(CAM-ICU)评估病人是否有POD,记录术中病人术中不良反应发生情况,记录术中药物使用情况以及术后留置气管导管时间、皮瓣存活情况等。结果:术后第1天POD发生率BIS组11.8%(4/34)低于非BIS组为38.2%(13/34)(P<0.05);术后第5天POD发生率BIS组8.8%(3/34)低于非BIS组29.4%(10/34)(P<0.05)。同时,BIS监测可减少术中丙泊酚用量,减少术中低血压发生,降低术中麻黄碱使用率。2组病人的苏醒延迟、术中知晓发生率及瑞芬太尼用量差异无统计学意义(P>0.05),2组病人的皮瓣存活率差异无统计学意义(P>0.05)。结论:BIS监测可降低老年口腔癌根治术病人POD的发生率,对病人术后皮瓣存活率无显著影响。

Objective To monitor the depth of anesthesia during general anesthesia using bispectral index(BIS),and investigate the influence of BIS monitoring on postoperative delirium(POD)and survival of flap in aged patients undergoing radical resection of oral cancer.Methods A total of 68 patients undergoing radical resection of oral cancer aged from 65 to 80 years,with ASA physical statusⅠ-Ⅲwere randomly divided into two groups.The BIS group(n=34)underwent adjustment of anesthesia to maintain a BIS value between 45-60.The non-BIS group(n=34)underwent standard intraoperative hemodynamic monitoring.The POD was assessed 1 day and 5 days after operation using confusion assessment method for intensive care unit(CAM-ICU).The occurrence of adverse reactions during operation was recorded.The use of drugs during the operation,the time of indwelling tracheal catheter after the operation,and the survival of flap were recoded.Results The incidence of POD was lower in the BIS group[11.8%(4/34)]compared with non-BIS group[38.2%(13/34)]on the first day after operation(P<0.05).The incidence of POD was lower in the BIS group[8.8%(3/34)]compared with non-BIS group[29.4%(10/34)]on the fifth day after surgery(P<0.05).Meanwhile,BIS monitoring could reduce the use of propofol during operation,reduce the occurrence of hypotension during operation,and reduce the use rate of ephedrine during operation.There was no significant difference in the delayed recovery,intraoperative awareness rate and remifentanil dosage between the two groups(P>0.05),and there was no significant difference in the survival rate of flap between the two groups(P>0.05).Conclusions BIS monitoring can reduce the incidence of POD in the elderly patients undergoing radical resection of oral cancer,but has no significant impact on the survival rate of flaps after surgery.