不同麻醉深度对内镜手术老年患者血流动力学指标、认知功能及术后谵妄的影响

Influence of varying anesthesia depths on hemodynamic parameters,cognitive function,and postoperative delirium in elderly patients undergoing endoscopic surgery

目的探讨麻醉深度对内镜手术老年患者血流动力学指标、认知功能及术后谵妄的影响。方法抽取2020年5月至2022年10月在河南科技大学第一附属医院行内镜手术治疗的120例老年患者为研究对象,根据脑电双频指数(BIS)标定的不同麻醉深度将患者分为浅度组(BIS为46-59)与深度组(BIS为30-45),每组60例。对比两组患者术中不同时间点的心率、平均动脉压水平和术前、术后3 d和术后7 d的简易智力状态检查量表(MMSE)评分,同时对比两组患者术后谵妄发生率。结果在气管插管后5 min(T2)、手术开始(T3)时,深度组心率、平均动脉压均低于浅度组(P<0.05),其他时间点两组患者心率、平均动脉压比较差异未见统计学意义(P>0.05);术后3 d,深度组MMSE评分高于浅度组(P<0.05),而两组患者术前及术后7 d MMSE评分比较差异未见统计学意义(P>0.05);深度组术后谵妄发生率(3.33%,2/60)低于浅度组(15.00%,9/60),P<0.05。结论对内镜手术老年患者麻醉深度选择BIS为30-45,能维持患者术中血流动力学稳定,降低术后谵妄发生率。

Objective To investigate the effect of varying anesthesia depths on hemodynamic parameters,cognitive function,and postoperative delirium in elderly patients undergoing endoscopic surgery.Methods A total of 120 elderly patients who underwent endoscopic surgery in the First Affiliated Hospital of Henan University of Science and Technology from May 2020 to October 2022 were selected as research objects.According to the depth of anesthesia calibrated by bispectral index(BIS),the patients were divided into shallow group(BIS 46-59)and deep group(BIS 30-45),with 60 cases in each group.Heart rate at different time points,mean artery pressure,and preoperative,3-and 7-day postoperative mini-mental state examination scale(MMSE)scores were compared between the two groups.The incidence of postoperative delirium of the two groups were compared.Results At 5 minutes after endotracheal intubation(T2)and the beginning of surgery(T3),the heart rate and average artery pressure of the deep group were lower than those of the shallow group(P<0.05).However,there was no statistical difference in heart rate and average artery pressure between the two groups at other time points(P>0.05).Three days after surgery,the MMSE score of the deep group was higher than that of the shallow group(P<0.05),but there was no statistical in MMSE score difference between the two groups before and 7 days after surgery(P>0.05).The incidence of postoperative delirium in the deep group(3.33%,2/60)was lower than that in the shallow group(15.00%,9/60),P<0.05.Conclusions In elderly patients undergoing endoscopic surgery,anesthesia depth based on BIS of 30-45 can maintain the stability of intraoperative hemodynamics and reduce the incidence of postoperative delirium.