不同镇静深度对轻度认知功能障碍老年患者术后认知功能的影响  

Effects of different depths of sedation on postoperative cognitive function in elderly patients with mild cognitive impairment

作　　者：李红[1] 刘叶 吴军娜 岳婷[1] 何馄 苏江涛[1] 张瑾[1] 张秀琴[2] Li Hong;Liu Ye;Wu Junna;Yue Ting;He Kun;Su Jiangtao;Zhang Jin;Zhang Xiuqin(Department of Anesthesiology, Shijiazhuang Fourth Hospital, Shijiazhuang 050000,China;Department of Operating Room,Shijiazhuang Fourth Hospital,Shijiazhuang 050000,China)

机构地区：[1]石家庄市第四医院麻醉科,050000 [2]石家庄市第四医院手术室,050000

出　　处：《中华麻醉学杂志》2018年第12期1437-1440,共4页Chinese Journal of Anesthesiology

摘　　要：目的评价不同镇静深度对轻度认知功能障碍老年患者术后认知功能的影响。方法择期全麻下行妇科手术的患者100例,年龄65~75岁,体重55~75kg,ASA分级Ⅱ或Ⅲ级,术前合并轻度认知功能障碍,采用随机数字表法分为2组(n=50):采用闭环靶控输注丙泊酚,自动调节血浆靶浓度,Ⅰ组维持BIS值40~50,Ⅱ组维持BIS值>50~60。分别于术前1d(T0)和术后7d(T1)时,采用蒙特利尔认知量表(MoCA)和简易精神状态量表(MMSE)评估认知功能,记录术后认知功能障碍(POCD)的发生情况。于上述时点采集静脉血样,采用ELISA法测定血清IL-10和TNF-α的浓度。结果与T0时比较,2组患者T1时MoCA评分和MMSE评分降低,血清IL-10和TNF-α浓度升高(P<0.05)。与Ⅰ组比较,Ⅱ组T1时MoCA评分和MMSE评分降低,POCD发生率升高,血清TNF-α浓度升高,血清IL-10浓度降低(P<0.05)。结论术中维持BIS值40~50可降低轻度认知功能障碍老年患者POCD的发生,可能与全身炎症反应减轻有关。Objective To evaluate the effects of different depths of sedation on postoperative cognitive function in elderly patients with mild cognitive impairment. Methods A total of 100 patients with mild cognitive impairment before surgery, aged 65-75 yr, weighing 55-75 kg, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective gynecological surgery under general anesthesia, were divided into Ⅰ and Ⅱ groups (n=50 each) using a random number table method.Propofol was given by closed-loop target-controlled infusion, and the target plasma concentration was automatically regulated.The bispectral index value was maintained at 40-50 in group Ⅰand at>50-60 in group Ⅱ.Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were used to evaluate the cognitive function at 1 day before operation (T0) and 7 days after operation (T1), and the development of postoperative cognitive dysfunction (POCD) was recorded.Venous blood samples were collected at T0 and T1 for determination of the concentrations of serum interleukin-10 (IL-10) and tumor necrosis factor-alpha (TNF-α) by enzyme-linked immunosorbent assay. Results Compared with the baseline value at T0, MoCA and MMSE scores were significantly decreased at T1, and the serum concentrations of IL-10 and TNF-α were increased in both groups (P<0.05). Compared with group Ⅰ, MoCA and MMSE scores were significantly decreased at T1, and the incidence of POCD was increased, the serum concentration of TNF-α was increased, and the serum concentration of IL-10 was decreased in groupⅡ(P<0.05). Conclusion Maintaining BIS value at 40-50 during operation can decrease the development of POCD in elderly patients with mild cognitive impairment, which may be related to reduced systemic inflammatory responses.

关 键 词：脑电描记术 认知障碍 老年人 

分 类 号：R614[医药卫生—麻醉学]