脑状态指数监测对老年人七氟烷麻醉术后认知功能的研究  

Decreasing Effect on Postoperative Cognitive Dysfunction During Cerebral State Index (CSI) to Monitor Depth of Sevoflurane Inhalation Anesthesia in Elderly Patients

作　　者：陈益君[1] 周海东[1] 杨赵栋 陆正荷[1] 黄长顺[1] 卢子会[1] 

机构地区：[1]浙江省宁波市第一医院麻醉科,宁波315010

出　　处：《中国中西医结合外科杂志》2010年第5期544-547,共4页Chinese Journal of Surgery of Integrated Traditional and Western Medicine

基　　金：浙江省医学会临床科研基金(2009ZYC28)

摘　　要：目的:观察脑状态指数(CSI)对于减少老年人七氟烷麻醉术后早期认知功能障碍的作用。方法:择期行上腹部手术患者,其中老年组(65～79岁)、中年组(45～59岁)各20例。术中七氟烷吸入浓度以确保CSI值在40～60的范围为准,比较两组患者的一般资料、术后麻醉恢复及认知功能情况。结果:老年组维持临床麻醉深度所需的七氟烷MAC明显小于中年组(P<0.01),均无术中知晓发生,两组睁眼时间、拔管时间及麻醉前、应答后1h、1d、3d的MMSE评分差异均无显著性(P>0.05),老年组应答时间及术后6h的MMSE评分比中年组差(P<0.05)。结论:临床麻醉中要根据患者的年龄选择合适的七氟烷吸入浓度,CSI可以作为调节七氟烷麻醉深度的一个重要监测指标,有利于减少老年患者术后出现POCD。Objective To observe the decreasing effect on postoperative cognitive function by Cerebral State Index （CSI） monitoring the depth of sevoflurane inhalation anesthesia in the elderly patients. Methods Forty patients undergoing upper abdominal surgery were divided into two groups： the older group, aged 65 to 79 years old and the middle-aged group, aged 45 to 59 years old, 20 patients each. Anesthesia was maintained with sevoflurane inhalation of 1%～4%, while intravenous continuous infusion of cis-acid atracurium 1～3 μg/（kg.min） and remifentanil 0.15μg/（kg.min） during intraoperation. The concentration of sevoflurane inhalation was adjusted to ensure the CSI being 40 to 60. The following parameters were compared： the general information, CSI, and sevoflurane minimum alveolar concentration （MAC） values; the eyes open time after anesthesia, extubation and responsion time; the mini-mental state examination （MMSE） score before anesthesia, after answering 1h, 6h, 1d and to 3d evaluate the cognitive function. Results Comparing the two groups of patients with gender, weight, ASA classification, educational level, operation time, intraoperating blood loss, the amount of remifentanil, cis-atracurium acid volume and CSI, there were no differences significantly （P 0.05）; the older group’s MAC if sevoflurane was significantly less than that in the middle-aged group （P 0.05） to maintain the clinical depth of anesthesia. There was no intraoperating awareness, the older group’s responsion time, MMSE score （6h after response） were worse than those in the middle-aged group （P 0.05）. Conclusion Appropriate concentration of sevoflurane inhalation should be adjusted according to the patient’s age. CSI can be used as an important monitoring reference to adjust the concentration of sevoflurane inhalation, helping to decrease the effect of POCD in elderly patients.

关 键 词：脑状态指数 老年病人 七氟烷吸入麻醉 术后认知功能障碍 

分 类 号：R614.21[医药卫生—麻醉学]