腹腔镜胃肠道肿瘤根治术中区域脑氧饱和度监测对合并高血压伴衰弱老年患者的影响  

The Impact of Regional Cerebral Oxygen Saturation Monitoring on Elderly Patients with Hypertension and Debilitation Undergoing Laparoscopic Radical Resection of Gastrointestinal Tumors

作　　者：王洋 徐桂萍[1] 瞿莉[1] 陈哲 Wang Yang;Xu Guiping;Qu Li;Chen Zhe(Department of anesthesiology,People′s Hospital of Xinjiang Uygur Autonomous Region,Xinjiang Clinical Research Center for AnesthesiaManagement,Urumqi 830000)

机构地区：[1]新疆维吾尔自治区人民医院麻醉科、新疆麻醉管理临床医学研究中心,乌鲁木齐830000

出　　处：《国际老年医学杂志》2024年第3期332-337,共6页International Journal of Geriatrics

基　　金：自治区重点研发计划项目(2022B03009-4)。

摘　　要：目的 探讨腹腔镜胃肠道肿瘤根治术中行区域脑氧饱和度(rSO_(2))监测对合并高血压伴衰弱的老年患者术后早期认知功能、炎症因子和氧化应激的影响。方法 选取2022年7月-2023年6月新疆维吾尔自治区人民医院收治的80例择期全麻下行腹腔镜胃肠道肿瘤根治术的合并高血压伴衰弱的老年患者作为研究对象,采用随机数字表法分为对照组和研究组,各40例。对照组未使用rSO_(2)监测,研究组接受rSO_(2)监测。记录手术前后简易智力状态检查量表(MMSE)和蒙特利尔认知评估量表(MoCA)评分,评估术后认知功能障碍(POCD)发生率。检测手术前后血清中枢神经特异蛋白(S100β)、神经元特异性烯醇化酶(NSE)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)、超氧化物歧化酶(SOD)、丙二醛(MDA)水平。记录术中丙泊酚、瑞芬太尼、舒芬太尼的用量及血管活性药物使用情况。采用数字模拟评分法(NRS)对术后2 h、4 h、8 h、12 h的疼痛程度进行评估。结果 术后1天,研究组MMSE与MoCA评分低于术前,且低于同期的对照组,差异均有统计学意义(P<0.05)。研究组术后1天POCD发生率低于对照组(P<0.05)。术后1天,两组血清S100β、NSE、IL-6、TNF-α、CRP、MDA水平均高于术前(P<0.05),且研究组各指标均低于对照组(P<0.05)。术后1天,两组SOD水平均低于术前(P<0.05),且研究组SOD水平高于对照组(P<0.05)。研究组术中丙泊酚和瑞芬太尼用量少于对照组(P<0.05);两组舒芬太尼用量比较,差异无统计学意义(P>0.05);研究组血管活性药物使用率低于对照组(P<0.05)。两组术后各时间点的NRS评分比较,差异均无统计学意义(P>0.05)。结论 腹腔镜胃肠道肿瘤根治术监测rSO_(2)变化,实施目标导向管理,对高血压伴衰弱的老年患者术后早期认知功能具有保护作用,可有效减少炎症因子分泌,降低氧化应激反应,降低POCD发生风险。Objective To investigate the effects of regional cerebral oxygen saturation(rSO_(2))monitoring and target-oriented management on early cognitive function,inflammatory factors and oxidative stress in elderly patients with hypertension and asthenia after laparoscopic radical resection of gastrointestinal tumors.Methods A total of 80 elderly patients with hypertension and asthenia who planned to undergo laparoscopic radical resection of gastrointestinal tumors under elective general anesthesia and were treated in the People′s Hospital of Xinjiang Uygur Autonomous Region from July 2022 to June 2023 were selected as the study objects,they were divided into 2 groups by random number table method,each group had 40 cases.The control group did not use rSO_(2) monitoring,while the study group received rSO_(2) monitoring.Before and after surgery,the scores of the mini-mental state examination(MMSE)and the montreal cognitive assessment(MoCA)were recorded to evaluate the incidence of postoperative cognitive dysfunction(POCD).Serum levels of S100β,neuron specific enolase(NSE),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),superoxide dismutase(SOD)and malondialdehyde(MDA)were measured before and after surgery.The dosage of propofol,remifentanil,sufentanil and vasoactive drugs were recorded during the operation.Numerical rating scale(NRS)was used to evaluate the pain degree of the patients at 2 h,4 h,8 h and 12 h after surgery.Results After one day of surgery,the study group exhibited significantly lower MMSE and MoCA scores compared to their preoperative scores,as well as lower scores than the control group during the same period(P<0.05).Additionally,the incidence of POCD in the study group was significantly lower than that in the control group after one day of surgery(P<0.05).Furthermore,postoperative serum levels of S100β,NSE,IL-6,TNF-α,CRP and MDA were higher in both groups compared to preoperative levels(P<0.05),but these levels were significantly lower in the study group compared to the c

关 键 词：区域脑氧饱和度监测 衰弱 高血压 胃肠道 肿瘤 认知 

分 类 号：R735[医药卫生—肿瘤] R544.1[医药卫生—临床医学]