Narcotrend指数联合SjvO2监测对老年患者腹腔镜手术后认知功能评定的临床观察  

Clinical observation of Narcotrend index combined with SjvO2 monitoring on postoperative cognitive function evaluation of elderly patients after laparoscopic surgery

作　　者：李瑞钰 王韬 李欢 卢增停 屈芸娜 LI Ruiyu;WANG Tao;LI Huan;LU Zengting;QU Yunna(Department of Ane sthesiology,Xiaolan Hospital Affiliated to Southern Medical University,Zhongshan 528415,China;Central sterile supply Department,Xiaolan Hospital Affiliated to Southern Medical University)

机构地区：[1]南方医科大学附属小榄医院麻醉科,广东中山528415 [2]南方医科大学附属小榄医院消毒供应中心

出　　处：《包头医学院学报》2019年第12期4-6,共3页Journal of Baotou Medical College

基　　金：广东省中山市科学技术局基金项目(2015B1068)。

摘　　要：目的:观察Narcotrend指数联合血氧饱和度(SjvO2)监测对老年患者腹腔镜手术后认知功能评定的影响。方法:选取ASA分级Ⅰ-Ⅱ级、年龄>60岁行腹腔镜手术患者90例,随机分成3组(N1、N2、N3),3组患者采用相同的监测、麻醉诱导和维持用药、复苏方法,床旁超声引导下行右颈内静脉入路逆行穿刺置管到位,采血检测颈静脉球部SjvO2,术中使3个组Narcotrend指数维持至预设的3种水平(N1=60±3、N2=45±3、N3=30±3),各组每隔20 min分别记录在预设区间内平均动脉压(MAP)、心率(HR)、脉搏氧饱和度(SPO2)、多巴胺的总用量、麻醉深度的Narcotrend指数(NI)、颈静脉球部SjvO2、分别术前1 d、术后1 d、3 d、7 d用简易精神状态评价量表(MMSE)、蒙特利尔认知评估量表(MoCA)评分。结果:与N1组比较,N2组、N3组T1-T4时点HR下降(P<0.05),多巴胺总用量增加(P<0.05);与N1、N2组比较,N3组T1-T4时点SjvO2下降(P<0.05);与术前1 d比较,N1组术后1 d MMSE评分、MoCA评分下降(P<0.05),N3组术后1 d、3 d、7 d MMSE评分、MoCA评分下降(P<0.05);与N2组比较,N1组术后1 d MMSE评分、MoCA评分下降(P<0.05),N3组术后1 d、3 d、7 d MMSE评分、MoCA评分下降(P<0.05)。结论:联合Narcotrend和SjvO2监测发现麻醉深度过浅或过深、SjvO2下降时会出现术后早期认知功能障碍(POCD),术中应维持合适的麻醉深度,避免SjvO2下降,能有效预防早期POCD。Objective:To observe the influence of Narcotrend index combined with SjvO2 monitoring on postoperative cognitive function in elderly patients after laparoscopic surgery.Methods:90 patients over 60 years of age(ASAⅠ~Ⅱ)who were to undergo laryngoscope surgery were randomly divided into three groups(N1、N2、N3).The three groups were received the same monitoring,anesthesia induction,maintenance and recovery methods.The right internal jugular vein puncture catheters were placed retrogradely under the ultrasound guidance to test the blood oxygen saturation.Narcotrend index of three groups were maintained to three levels(about N1=60、N2=45、N3=30)during the operation.The MAP、HR、SPO2、Total dosage of dopamine、NI and SjvO2 were recorded every 20 minutes in preset interval.The MMSE and MoCA were recorded in 1 day before operation,in 1 day、3 days and 7 days after operation respectively.Result:Compared with group N1,HR was significantly decreased(P<0.05)at T1~T4 in Group N2、N3.Compared with group N1,total dosage of dopamine was significantly increased(P<0.05)in Group N2、N3.Compared with group N1 and N2,SjvO2 was significantly decreased(P<0.05)at T1~T4 in Group N3.Compared with 1 day before operation,MMSE and MoCA of 1 day after operation were significantly decreased(P<0.05)in Group N1,MMSE and MoCA of 1 day、3 days and 7 days after operation was significantly decreased(P<0.05)in Group N3.Compared with group N2,MMSE and MoCA of 1 day after operation were significantly decreased(P<0.05)in Group N1,MMSE and MoCA of 1 day、3 days and 7 days after operation were significantly decreased(P<0.05)in Group N3.Conclusion:On depth of anesthesia,the early postoperative cognitive dysfunction(POCD)was found was too shallow or too deep,and SjvO2 decreased through Narcotrend index combined with SjvO2 monitoring.We should maintain the right depth of anesthesia and prevent SjvO2 from falling,and effectively prevent POCD.

关 键 词：老年 NARCOTREND 颈静脉球部血氧饱和度 认知功能 

分 类 号：R61[医药卫生—外科学]