麻醉镇静深度对老年腹腔镜手术患者早期术后认知功能的影响  

Effects of the depth of anesthesia and sedation on early postoperative cognitive function in elderly patients undergoing laparoscopic surgery

作　　者：张春璐 罗婵 王丹阳 陈鹏[1] ZHANG Chun-lu;LUO Chan;WANG Dan-yang(Department of Anesthesiology,China-Japan Union Hospital of Jilin University,Changchun 130033,China)

机构地区：[1]吉林大学中日联谊医院麻醉科,吉林长春130033 [2]四川大学华西第二医院麻醉科

出　　处：《中国实验诊断学》2021年第4期503-506,共4页Chinese Journal of Laboratory Diagnosis

基　　金：吉林省直卫生专项项目(3D518U983430)。

摘　　要：目的观察麻醉镇静深度对老年腹腔镜手术患者术后早期认知功能的影响。方法腹腔镜下直肠癌或结肠癌根治术老年病人80例,以地氟烷复合瑞芬太尼进行麻醉维持,以BIS标定麻醉镇静深度,随机分为深麻醉组(A组,BIS值30-45)和对照组(B组,BIS值45-59),每组各40例。记录两组病人不同时点BIS值、平均动脉压(MAP)、心率(HR)、清醒拔管时间。术后第1天、第3天、第7天对病人进行术后认知功能障碍(POCD)的早期评估。结果术后第1天和第3天B组病人MMSE评分显著低于A组(P<0.05)。A组在术后第1天时MMSE评分显著低于术前(P<0.05),第3天恢复至术前水平;B组病人在术后第1天及第3天时MMSE评分显著低于术前(P<0.05),第7天恢复至术前水平。术后第1天及第3天,B组患者POCD的发生率明显高于A组,差异具有统计学意义(P<0.05)。结论以脑电双频指数为导向的地氟烷复合瑞芬太尼的麻醉方式,深麻醉组(BIS值30-45)病人早期术后认知功能障碍的发生率较低。Objective To observe the effect of anesthetic sedation depth on early postoperative cognitive function in elderly patients undergoing laparoscopic surgery.Methods Eighty patients undergoing laparoscopic radical resection of rectal cancer or colon cancer were treated with desflurane combined with remifentanil for anesthesia maintenance,and BIS determined the depth of anesthesia and sedation.They were randomly divided into deep anesthesia group(group A,BIS value 30-45)and control group(group B,BIS value 45-59),with 40 cases in each group.BIS value,mean arterial pressure(MAP),heart rate(HR),and patients’waking extubation time in two groups were recorded.Early assessment of postoperative cognitive dysfunction(POCD)was performed on postoperative day 1,3,and 7.Results MMSE score of group B was significantly lower than that of group A on a postoperative day 1 and day 3(P<0.05).In group A,MMSE score was significantly lower than that before operation on the first day after operation(P<0.05)and recovered to the level before operation on the third day.In group B,the MMSE score was significantly lower than that before operation on the 1 st and 3 rd day after surgery(P<0.05)and recovered to the level before operation on the 7 th day.On the first and third postoperative days,the incidence of POCD in group B was significantly higher than that in group A,with statistical significance(P<0.05).Conclusion In patients with deep sedation anesthesia(BIS 30-45),the incidence of early postoperative cognitive dysfunction was lower under the bispectral index oriented anesthesia of desflurane combined with remifentanil.

关 键 词：脑电双频指数 地氟烷 瑞芬太尼 术后认知功能障碍 

分 类 号：R971.2[医药卫生—药品]