脑电监测指导下全麻对非急性期脆弱脑功能老年患者术后谵妄的影响  

Effect of general anesthesia guided by electroencephalography monitoring on postoperative delirium in elderly patients with non-acute fragile brain function

作　　者：赵彩奕 刘欣[1] 李昭[1] 石娜[1] 赵楠 刘飞飞[1] 吴川[1] 王秀丽[1] Zhao Caiyi;Liu Xin;Li Zhao;Shi Na;Zhao Nan;Liu Feifei;Wu Chuan;Wang Xiuli(Department of Anesthesiology,The Third Hospital of Hebei Medical University,Shijiazhuang 050051,China)

机构地区：[1]河北医科大学第三医院麻醉科,石家庄050051

出　　处：《中华麻醉学杂志》2021年第6期651-655,共5页Chinese Journal of Anesthesiology

基　　金：国家自然科学基金(81971001);河北省适宜卫生技术推广项目(P20190020)。

摘　　要：目的:评价脑电监测指导下全麻对非急性期脆弱脑功能老年患者术后谵妄的影响。方法:选择行髋关节置换术的非急性期脆弱脑功能老年患者60例,性别不限,年龄65~85岁,BMI 18~30 kg/m^(2),ASA分级Ⅱ或Ⅲ级,采用随机数字表法分为2组(n=30):常规全麻组(C组)和脑电监测指导下全麻组(E组)。静脉输注丙泊酚50~150μg·kg^(-1)·min^(-1)和瑞芬太尼0.05~0.30μg·kg^(-1)·min^(-1)维持麻醉,间断追加罗库溴铵维持肌松。E组出现脑电暴发抑制[脑电暴发抑制比≥10%超过1 min或麻醉意识指数(AI)<40]时,减少麻醉药物用量,观察1 min后若仍存在上述情况,继续减少药物用量或静脉注射去甲肾上腺素。C组根据血流动力学变化调整术中麻醉药物用量。术中发生低血压时,结合患者HR静脉注射去甲肾上腺素4~10μg或多巴胺1 mg。于麻醉诱导后10 min、切皮即刻、术毕即刻和术后1 h时,采集动脉及颈静脉球部血样行血气分析,计算颈静脉球部血氧含量、动脉-颈静脉球部血氧含量差、脑氧摄取率及颈静脉-动脉血乳酸浓度差。记录苏醒时间、术中麻醉药物用量和去甲肾上腺素使用情况、术中脑电暴发抑制累计时间和AI<40时间。采用ICU意识模糊评定量表评估术后5 d内谵妄发生情况,并记录其持续时间。结果:与C组比较,E组苏醒时间、暴发抑制累计时间和AI<40时间缩短,术中丙泊酚用量和瑞芬太尼用量降低,术中去甲肾上腺素使用率升高,术毕即刻和术后1 h时颈静脉球部血氧含量升高,动脉-颈静脉球部血氧含量差和脑氧摄取率降低,术后5 d内谵妄发生率降低,持续时间缩短(P<0.05)。结论:脑电监测指导下全麻可减少非急性期脆弱脑功能老年患者术后谵妄的发生。Objective To evaluate the effect of general anesthesia guided by electroencephalography(EEG)monitoring on postoperative delirium(POD)in elderly patients with non-acute fragile brain function.Methods Sixty patients of both sexes with non-acute fragile brain function,aged 65-85 yr,of American Society of Anesthesiologists physical statusⅡorⅢ,with body mass index of 18-30 kg/m^(2),undergoing hip replacement,were divided into 2 groups(n=30 each)by a random number table method:conventional general anesthesia group(group C)and general anesthesia guided by EEG monitoring group(group E).Anesthesia was maintained by intravenous infusion of propofol 50-150μg·kg^(-1)·min^(-1) and remifentanil 0.05-0.30μg·kg^(-1)·min^(-1) and intermittent intravenous boluses of rocuronium.In group E,the dose of anesthetic was reduced when the EEG burst-suppression ratio≥10%for more than 1 min or anesthesia index(AI)<40.If the situation mentioned above still existed after 1 min,the dose of anesthetic was continued to be reduced or norepinephrine was injected intravenously.In group C,the amount of intraoperative anesthesia was adjusted according to the changes in hemodynamics.Norepinephrine 4-10μg or dopamine 1 mg was given intravenously in the light of the patients′heart rates when intraoperative hypotension occurred.At 10 min after anesthesia induction,immediately after skin incision,immediately at the end of surgery and at 1 h after surgery,blood samples were obtained from the artery and jugular venous bulb for blood gas analysis and for calculation of jugular bulb blood oxygen content(CjvO_(2)),artery-jugular bulb blood oxygen content difference(Ca-jvO_(2)),cerebral oxygen uptake rate(CERO_(2))and jugular-arterial blood lactate concentration difference(Djv-aLac).The emergence time,amounts of intraoperative anesthetics,use of noradrenaline,cumulative time of EEG burst inhibition and duration of AI<40 were recorded.The development of POD was assessed within 5 days after surgery by the confusion assessment method for the intensi

关 键 词：脑电描计术 麻醉 全身 老年人 谵妄 手术后并发症 脆弱脑功能 

分 类 号：R614[医药卫生—麻醉学]