基于脑电双频指数的不同麻醉深度对老年腹腔镜手术患者术后认知功能障碍的影响  

Effect of different anesthesia depths based on bispectral index on postoperative cognitive dysfunction in elderly patients undergoing laparoscopic surgery

作　　者：叶兴道 李秀蒲 杨光斌 YE Xing-dao;LI Xiu-pu;YANG Guang-bin(Dianbai People's Hospital,Maoming 525400,China)

机构地区：[1]广东省茂名市电白区人民医院,广东茂名525400

出　　处：《广东医科大学学报》2021年第2期209-212,共4页Journal of Guangdong Medical University

摘　　要：目的了解基于脑电双频指数的不同麻醉深度对老年腹腔镜手术患者术后认知功能障碍的影响。方法120例老年腹腔镜术患者随机分成A、B、C组,每组40例。麻醉期间根据各组设定的脑电双频指数(A组50~60,B组40~<50,C组30~<40)对瑞芬太尼和丙泊酚输入速度进行合理调整。记录患者麻醉前1 d和手术后第1、3、7天的简易精神状态量表评分,麻醉前及术后第1天连接测试完成时间,手术过程中瑞芬太尼使用剂量、丙泊酚使用剂量及术后清醒时间,术后7 d内认知功能障碍的发生率。结果术后第1、3天C组患者的简易精神状态量表评分最低,B组次之,A组最高(P<0.01);术后第7天,C组患者的简易精神状态量表评分低于A、B组(P<0.01)。A、B组患者术后第1天的连接测试完成时间均短于同组麻醉前1 d(P<0.05或0.01)。术后第1天A组测试完成时间最短,B组次之,C组最长(P<0.01)。术后7 d内,A、B、C组认知功能障碍发生率分别为2.5%、7.5%、17.5%,差异无统计学意义(P>0.05)。A组患者术中的瑞芬太尼、丙泊酚使用剂量最少且术后清醒最快,B组次之,C组瑞芬太尼、丙泊酚使用剂量最多且术后清醒最慢(P<0.01)。结论老年腹腔镜手术患者在深度麻醉作用下会产生一定的认知障碍,而且麻醉深度越浅患者产生认知功能障碍的风险越低,在临床上要结合患者的实际耐受度来合理控制麻醉程度。Objective To investigate the effect of different anesthesia depths based on bispectral index on postoperative cognitive dysfunction in elderly patients undergoing laparoscopic surgery.Methods A total of 120 elderly patients that have received laparoscopic surgery were randomly divided into Group A,B and C,40 patients in each group.During the anesthesia,the infusion speed of remifentanil and propofol was adjusted reasonably according to the bispectral index(50~60 for Group A,40~<50 for Group B,and 30~<40 for Group C)set for each group.The mini-mental state examination(MMSE)scores at 1d before the anesthesia and on Day 1,3 and 7 after surgery of patients,the completion time of connection test before anesthesia and on Day 1 after surgery,the dosage of remifentanil and propofol during the operation,postoperative waking time and incidence of cognitive dysfunction within 7 d after surgery were recorded.Results The MMSE score on Day 1 and 3 after surgery was the lowest in Group C,followed by Group B,and then Group A(P<0.01).On Day 7 after surgery,the MMSE score in Group C was lower than that in Group A and B(P<0.01).The completion time of connection test on Day 1 after surgery was shorter than that on 1d before anesthesia in Group A and Group B(P<0.05 or 0.01).On Day 1 after surgery,Group A had the shortest time to complete the test,followed by Group B,and then Group C(P<0.01).Within 7 d after surgery,the incidence of cognitive dysfunction was 2.5%in Group A,7.5%in Group B,and 17.5%in Group C,but the difference was not statistically significant(P>0.05).Group A received the least dosage of remifentanil and propofol during the surgery and woke up the fastest after surgery,followed by Group B,and then Group C(P<0.01).Conclusion The elderly patients who have received laparoscopic surgery will have certain cognitive dysfunction under deep anesthesia,and the lower the anesthesia depth,the lower the risk of cognitive dysfunction.Therefore,the anesthesia depth should be controlled reasonably in clinical practice based on the pa

关 键 词：麻醉深度 腹腔镜手术 老年患者 认识功能障碍 

分 类 号：R614[医药卫生—麻醉学]