不同麻醉深度对老年腹部手术患者术后认知功能的影响

Effects of different anesthetic depths on postoperative cognitive function in elderly patients undergoing abdominal surgery

目的:探讨不同麻醉深度对老年腹部手术患者术后认知功能的影响。方法:选取78例老年腹部手术患者作为研究对象,依据脑电双频指数(BIS)不同将患者分为对照组(浅麻醉,BIS≥45)和研究组(深麻醉,30<BIS<45),每组各39例。比较两组患者手术相关指标、血流动力学指标、白细胞介素6(IL-6)水平、中枢神经特异蛋白(S-100β)水平、简易精神状态检查表(MMSE)评分及术后认知功能障碍(POCD)发生率。结果:两组患者输液量、麻醉时间、术中出血量比较,差异均无统计学意义(P>0.05);研究组苏醒时间、拔管时间长于对照组(P<0.05);两组患者术后1、3 d,血清IL-6、S-100β水平先升高后降低(P<0.05),且研究组术后各时间均低于对照组(P<0.05);在麻醉后研究组T1、T2时间点的平均动脉压均高于对照组,T1、T2心率均低于对照组(P<0.05);术后1、3 d,研究组MMSE评分高于对照组;术后1、3、7 d,研究组POCD发生率均低于对照组(P<0.05)。结论:深度麻醉(BIS:30~45)可降低老年腹部手术患者发生POCD的几率及血清IL-6和S-100β水平,在减轻中枢神经系统损伤方面具有积极作用。

Objective:To explore the effect of different anesthesia depths on postoperative cognitive function in elderly patients undergoing abdominal surgery.Methods:A total of 78 elderly patients undergoing abdominal surgery were selected and divided into control group(shallow anesthesia,BIS≥45)and study group(deep anesthesia,30<BIS<45)according to the double-frequency index of brain,39 cases in each group.The changes of operation-related indexes,hemodynamic indexes,interleukin 6(IL-6)level,protein S-100β(S-100β)level,Mini-mental State Examination(MMSE)score and the incidence of Postoperative cognitive dysfunction(POCD)in the two groups were compared.Results:There was no significant difference in infusion volume,anesthesia time and blood loss between the two groups(P>0.05).The recovery time and extubation time of the study group were longer than that of the control group(P<0.05).The levels of IL-6 and S-100βat 1 and 3 d after surgery were higher than those before surgery(P<0.05),and the levels of IL-6 and S-100βat 3 d after surgery were lower than those at 1 d after surgery,and the levels in the study group were lower than those in the control group(P<0.05).The mean arterial pressure of the study group at T1 and T2 was higher than that of the control group(P<0.05),and the heart rate was lower than that of the control group(P<0.05).The MMSE score of the study group was higher than that of the control group at 1 and 3 d after surgery,and the incidence of POCD was lower than that of the control group at 1,3,and 7 d after surgery(P<0.05).Conclusion:Deep anesthesia(BIS:30-45)can reduce the incidence of POCD and the levels of IL-6 and S-100βin elderly patients undergoing abdominal surgery,and play a positive role in alleviating the damage of central nervous system.