BIS指导下全麻对腔镜胃肠肿瘤切除术老年患者术后疲劳综合征的影响  

Effect of general anesthesia under guidance of bispectral index on postoperative fatigue syndrome in elderly patients undergoing laparoscopic resection of gastrointestinal tumor

作　　者：隆巧玉 葛亚丽 腾永杰 刘智[1] 高巨 沈邮静 Long Qiaoyu;Ge Yali;Teng Yongjie;Liu Zhi;Gao Ju;Shen Youjing(Department of Anesthesiology,The First Hospital of Hunan University of Chinese Medicine,Changsha 410021,China;Department of Anesthesiology,Affiliated Clinical Medical College of Yangzhou University Northern Jiangsu People′s Hospital,Yangzhou 225000,China)

机构地区：[1]湖南中医药大学第一附属医院麻醉科,长沙410021 [2]扬州大学临床医学院,江苏省苏北人民医院麻醉科,扬州225000

出　　处：《中华麻醉学杂志》2022年第4期394-398,共5页Chinese Journal of Anesthesiology

基　　金：江苏省青年医学重点人才项目(QNRC2016337)。

摘　　要：目的评价BIS指导下全麻对腔镜胃肠肿瘤切除术老年患者术后疲劳综合征(POFS)的影响。方法择期行腔镜胃肠肿瘤切除术患者90例,年龄65~80岁,BMI 18~25 kg/m^(2),ASA分级Ⅰ~Ⅲ级,无术前疲劳。采用随机数字表法分为3组(n=30):对照组(C组)、BIS值40~49组(B1组)和BIS值50~60组(B2组)。采用静吸复合全麻。B1组术中BIS值维持40~49,B2组术中BIS值维持50~60、C组术中维持HR和MAP波动幅度不超过基础值的20%,必要时给予血管活性药物。术后采用舒芬太尼+地佐辛+帕洛诺司琼行PCIA,VAS评分>3分时,口服氨酚羟考酮片5 mg或静脉注射氟比洛芬酯50 mg进行补救镇痛。分别于术前1 d和术后1、3、7、30 d时行Christensen疲劳评分,记录POFS(Christensen疲劳评分≥6分)发生情况。记录术中丙泊酚、瑞芬太尼和舒芬太尼用量;分别于术前1 d和术后1 d,采用免疫比浊法测定血清C反应蛋白浓度。记录术后48 h内补救镇痛情况;记录术后首次排气时间、首次下床活动时间、住院时间和术后3 d内发热、呕吐和谵妄的发生情况。分别于术后1、3和7 d时行15项恢复质量量表(QoR-15)评分。结果与C组相比,B1组和B2组术后1、3和7 d时Christensen疲劳评分降低,术后7 d时POFS发生率降低,术后各时点QoR-15评分升高,住院时间缩短,术中丙泊酚用量减少(P<0.05)。与B1组比较,B2组术中丙泊酚用量减少,术后各时点QoR-15评分升高(P<0.05),术后各时点Christensen疲劳评分、各时点POFS发生率和住院时间差异无统计学意义(P>0.05)。3组间各时点血清C反应蛋白浓度、术后补救镇痛率、首次排气时间、首次下床时间和发热、呕吐、谵妄的发生率比较差异无统计学意义(P>0.05)。结论BIS指导下全麻可减轻腔镜胃肠肿瘤切除术老年患者POFS,促进术后早期恢复。Objective To evaluate the effect of general anesthesia under the guidance of bispectral index(BIS)on postoperative fatigue syndrome(POFS)in elderly patients undergoing laparoscopic resection of gastrointestinal tumor.Methods A total of 90 patients of both sexes,aged 65-80 yr,with body mass index of 18-25 kg/m^(2),of American Society of Anesthesiology physical statusⅠ-Ⅲ,undergoing elective laparoscopic resection of gastrointestinal tumor,were divided into 3 groups(n=30 each)using a random number table method:control group(C group),BIS value 40-49 group(B1 group),and BIS value 50-60 group(B2 group).Combined intravenous-inhalational anesthesia was used.The intraoperative BIS value was maintained at 40-49 in group B1,the intraoperative BIS value was maintained at 50-60 in group B2,and the fluctuation range of heart rate and mean arterial pressure was maintained within 20%of the baseline value during operation,and vasoactive drugs were given when necessary in group C.Patient-controlled intravenous analgesia was performed with sufentanil plus dezocine plus palonosetron after surgery,when the VAS score>3 points,oxycodone/acetaminophen tablets 5 mg were administered orally or flurbiprofen axetil 50 mg was intravenously injected for rescue analgesia.The Christensen′s Fatigue Scale(CFS)scores were recorded at 1 day before operation and 1,3,7 and 30 days after operation,and the development of POFS(CFS score≥6)was recorded.The intraoperative consumption of propofol,remifentanil and sufentanil was recorded.The serum C-reactive protein concentration was determined by immunoturbidimetry at 1 day before operation and 1 day after operation.The requirement for rescue analgesia within 48 h after operation was recorded.The time to the first flatus,the first ambulation time,length of hospital stay,and occurrence of fever,vomiting and delirium within 3 days after operation were recorded.The Quality of Recovery-15(QoR-15)scores were measured at 1,3 and 7 days after operation.Results Compared with group C,CFS scores were signifi

关 键 词：脑电描记术 麻醉 全身 老年人 疲劳 手术后并发症 

分 类 号：R735[医药卫生—肿瘤] R614[医药卫生—临床医学]