全凭静脉麻醉下不同BIS值对老年胃肠道恶性肿瘤患者围术期神经认知功能的影响  

Effects of different BIS value on perioperative neurocognitive function in elderly patients with gastrointestinal malignant tumors under TIVA

作　　者：李新灵[1] 艾吾再力·阿吉艾科拜尔 艾尼·买买提明 熊金敏 萨达凯提·艾买提 刘艳萍[1] 张冰[1] LI Xinling;Aiwuzaili Ajiaikebaier;Aini Maimaitiming;XIONG Jinmin;Sadakaiti Aimaiti;LIU Yanping;ZHANG Bing(Department of Anesethesiology,Affiliated Tumor Hospital,Xinjiang Medical University,Urumqi 830011,China)

机构地区：[1]新疆医科大学附属肿瘤医院麻醉科,乌鲁木齐830011

出　　处：《新疆医科大学学报》2022年第12期1437-1442,共6页Journal of Xinjiang Medical University

基　　金：新疆维吾尔自治区自然科学基金面上项目(2019D01C250);新疆医科大学附属肿瘤医院临床研究项目(2019CL02010)。

摘　　要：目的 探讨全凭静脉麻醉下不同镇静深度对老年胃肠道恶性肿瘤患者围术期神经认知功能的影响。方法 选取98例2020年10月至2021年4月期间新疆医科大学附属肿瘤医院实施胃肠道恶性肿瘤手术的65岁以上的老年患者作为研究对象,采用随机数字表法分为低脑电双频指数(Bispectral index,BIS)组和高BIS组,每组各49例。采用全凭静脉麻醉,术中均通过BIS指导镇静深度。统计两组患者术后7 d内谵妄(Postoperativedelirium,POD)和术后30 d内围术期神经认知障碍(Perioperative neurocognitive disorders,PND)的发生率,同时酶联接免疫吸附测定法(Enzyme-Linkedlmmunosorbnent Assay,ELISA)测定麻醉诱导前(T1)、术毕(T2)、术后24 h (T3)、术后72 h(T4)和术后7 d(T5)的S-100β蛋白、神经元特异性烯醇化酶(Neuron-specific enolase,NSE)、白细胞介素-6(interleukin-6,IL-6)和肿瘤坏死因子-α(Tumor necrosis factor-alpha,TNF-α)水平;采用限制性片段长度多态性聚合酶链反应技术(PCR-RFLP)检测患者的ApoE基因型;采用流式细胞技术测定两组患者5个时间点的CD3^(+)、CD4^(+)、CD8^(+)、人类白细胞抗原-DR^(+)CD4^(+)(Human leukocyte antigen-DR^(+)CD4^(+),HLA^(-)DR^(+)CD4^(+))、人类白细胞抗原-DR^(+)CD8^(+)(Human leukocyte antigen-DR^(+)CD8^(+),HLA^(-)DR^(+)CD8^(+))水平。结果 两组患者组内与组间各点PND与POD的发生率比较无统计学差异(P>0.05)。两组间S-100β蛋白、NSE、IL-6和TNF-α水平差异具有统计学意义(P<0.05)。两组间患者的CD3^(+)、CD4^(+)、CD8^(+)、HLA^(-)DR^(+)CD4^(+)、HLA^(-)DR^(+)CD8^(+)水平在不同时间点无明显统计学差异(P>0.05),但组内比较差异具有统计学意义(P<0.05)。结论 全凭静脉麻醉下维持不同的镇静深度对老年胃肠道恶性肿瘤患者短期内的围术期神经认知功能无显著影响。Objective To investigate the effect of different sedation depths under TIVA on perioperative neurocognitive function in elderly patients with gastrointestinal malignancy. Methods In this study, 98 elderly patients over 65years old who underwent gastrointestinal cancer surgery in the hospital from October 2020 to April 2021 were selected as the research objects. According to the depth of intraoperative intravenous anesthesia, the patients were divided into low BIS group(n= 49) and high BIS group(n= 49). The incidence of delirium 7 days after the surgery and PND 30 days after the surgery in the two groups were calculated. Meanwhile, the perioperative period(before anesthesia induction(T1), at the end of the surgery(T2), 24 h after the surgery(T3), 72 h after the surgery(T4) and 7days after the surgery T5) was determined by ELISA and S-100β protein, neuron specific enolase(NSE), interleukin 6(IL-6),(tumor necrosis factor-α) TNF-α inflammatory factors;ApoE genotype was detected by polymerase chain reaction restriction fragment length polymorphism(PCR-RFLP). Flow cytometry was used to determine whether there were significant differences in the levels of CD3^(+), CD4^(+), CD8^(+), HLA^(-)DR^(+)CD4^(+), HLA^(-)DR^(+)CD8^(+)at different time points(before anesthesia induction(T1), at the end of the surgery(T2), 24 h after the surgery(T3),72 h after the surgery(T4), and 7 days after the surgery T5) between the two groups. Results There was no significant difference in the incidence of PND and POD at all points between the two groups(P>0. 05). There were significant differences in s-100 β protein, NSE, IL-6, and TNF-α levels between the two groups(P<0. 05). There were no significant differences in the levels of CD3^(+), CD4^(+), CD8^(+), HLA^(-)DR^(+)CD4^(+), HLA^(-)DR^(+)CD8^(+)between the two groups at different time points(P>0. 05), but there were certain differences within the group, and the differences were statistically significant(P<0. 05). Conclusion Maintaining different depth of sedation under TIVA has no si

关 键 词：脑电双频指数 麻醉深度 胃肠道恶性肿瘤手术 围术期神经认知障碍 

分 类 号：R614.2[医药卫生—麻醉学]