两种麻醉深度对老年患者脑氧代谢和术后认知功能的影响  

The cerebral oxygen metabolism and postoperative cognitive function effects of different depth of anesthesia in elderly patients

作　　者：彭云[1] 李秋军[1] 王庚[1] 黄立宁[2] 

机构地区：[1]北京积水潭医院麻醉科,北京100035 [2]河北医科大学第二医院麻醉科,河北石家庄050005

出　　处：《临床和实验医学杂志》2015年第22期1853-1856,共4页Journal of Clinical and Experimental Medicine

基　　金：河北省卫生厅基金资助项目(20130464)

摘　　要：目的探讨两种麻醉深度对老年患者脑氧代谢和术后认知功能的影响。方法 2011年2月到2015年1月选择老年腹腔镜下胆囊切除术患者80例作为研究对象,根据麻醉深度不同分为观察组与对照组各40例。两组都采用静脉麻醉,对照组术中脑电双频指数（BIS）值维持在50～59间,观察组术中BIS值维持在30～39间。观察比较两组认知功能评分、脑氧代谢检测、不良反应情况以及麻醉效果。结果两组术后1 d的简易精神状态量表（MMSE）评分都明显低于术前（P〈0.05）,观察组术后7 d的MMSE评分明显高于对照组（P〈0.05）,同时与术前评分对比差异无统计学意义。两组麻醉诱导后30 min与术后时间点的动脉血氧含量（Ca O2）和混合静脉血氧含量（Cv O2）值明显低于术前（P〈0.05）,但不同时间点的Ca O2和Cv O2值的组间对比差异均无统计学意义（P〉0.05）。观察组的苏醒时间、拔管时间和定向力恢复时间都明显低于对照组,差异有统计学意义（P〈0.05）。治疗组术后7 d内恶心呕吐、低氧血症、肺部感染、切口感染等并发症发生率明显低于对照组（P〈0.05）。结论在老年腹腔镜下胆囊切除术患者中,相对于BIS值维持在50～59间,术中BIS值维持在30～39间对于脑氧代谢无明显负面影响,麻醉效果更好,能促进恢复术后认知功能,安全性好,值得推广应用。Objective To investigate the cerebral oxygen metabolism and postoperative cognitive function effects of different depth of anesthesia in elderly patients. Methods From February 2011 to January 2015,we selected 80 elderly patients with laparoscopic cholecystectomy for the study. All patients were equally divided the observation group and the control group by the different depth of anesthesia. Patients of both groups used intravenous anesthesia,the patients of control group intraoperative bispectral index（ BIS） values remained at 50 ～ 59 rooms,and the observation group BIS value was maintained at between 30 ～ 39. Results The postoperative 1 d MMSE scores were significantly lower than the preoperative in the two groups（ P 〈0. 05）,but the postoperative 7 d MMSE scores in the observation group were significantly higher（ P 〈0. 05）. While compared with the preoperative score,the difference were not statistically significant. The T2 and T3 time points arterial oxygen content（ Ca O2）and mixed venous oxygen content（ Cv O2） were significantly lower than the T1 time point（ P 〈0. 05）,but compared at different points in times of Ca O2 and Cv O2 values the differences between the groups were not statistically significant（ P 〉0. 05）. The recovery time,extubation time and orientation recovery time in the observation group were significantly lower. The differences were statistically significant（ P 〈0. 05）. The postoperative 7 d nausea and vomiting,hypoxemia,pulmonary infection,wound infection and other complications in the treatment group were significantly less than the control group（ P 〈0. 05）. Conclusion In elderly patients with laparoscopic cholecystectomy,the BIS value is maintained at between 50 ～ 59,the intraoperative BIS value is maintained at between 30- 39 cerebral oxygen metabolism for no apparent negative impact. This method has better anesthetic effect,can promote recovery of postoperative cognitive function,its safety and should be widely applied.

关 键 词：老年人 麻醉深度 脑电双频指数 脑氧代谢 认知功能 

分 类 号：R614[医药卫生—麻醉学]