不同麻醉深度对老年患者全麻术后脑损伤指标及炎症因子的影响  

Effects of different anesthesia depth on postoperative brain injury indicators and inflammatory mediators in elderly patients after general anesthesia

作　　者：朱梅桢 庄桂泉 翁越 林丽娜[1] ZHU Meizhen;ZHUANG Guiquan;WENG Yue;LIN Li’na(Department of Anesthesiology,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325015,China;Department of Anesthesiology,Weifang People’s Hospital,Weifang 261044,China)

机构地区：[1]温州医科大学附属第一医院麻醉科,浙江温州325015 [2]潍坊市人民医院麻醉科,山东潍坊261044

出　　处：《温州医科大学学报》2024年第10期823-827,共5页Journal of Wenzhou Medical University

摘　　要：目的:探讨推荐脑电双频谱指数(BIS)范围内维持不同麻醉深度对老年患者全麻术后脑损伤指标及炎症因子的影响。方法:选取2021年于温州医科大学附属第一医院择期行腹腔镜消化道肿瘤手术老年患者40例,根据随机数字表法将入选患者随机分为BIS40组和BIS55组,每组20例。两组均采用静脉诱导,吸入麻醉维持相应麻醉深度,其中BIS40组患者术中维持BIS值于40~45,BIS55组患者BIS维持于55~60。分别于诱导前(T0)、诱导完成后(T1)、气腹后即刻(T2)、取标本(T3)、冲洗(T4)、术毕(T5)、拔管(T6)和回病房(T7)即刻记录患者血流动力学指标;分别于术前、术后2、6和24 h采集静脉血测定血清脑红蛋白(NGB)、低氧诱导因子(HIF-α)、神经元特异性烯醇化酶(NSE)、S100-β、IL-6和TNF-α。结果:与BIS55组比较,BIS40组患者七氟烷用量更大,BIS值更低,且拔管所需时间延长(P<0.05)。BIS40组患者术后2 h血清TNF-α和IL-6水平低于BIS55组(P<0.05),其余时间点TNF-α和IL-6水平差异无统计学意义(P>0.05);各时点血清NGB、NSE、S100-β和HIF-α水平2组间差异均无统计学意义(P>0.05)。结论:推荐BIS范围内不同麻醉深度不影响老年患者全麻术后脑损伤指标,但BIS值于40~45的患者术后早期炎症因子水平更低。Objective:To investigate the effects of maintaining different depths of anesthesia within the recommended range of bispectral index on postoperative brain injury indices and inflammatory factors in elderly patients undergoing general anesthesia.Methods:A total of 40 elderly patients who underwent elective laparoscopic gastrointestinal tumor surgery at the First Affiliated Hospital of Wenzhou Medical University in 2021 were included in this study,who were randomly divided as the BIS40 group and the BIS55 group according to the random number table method,with 20 cases in each group.Both groups underwent intravenous induction,and inhalation anesthesia was used to maintain the appropriate depth of anesthesia,in which the intraoperative bispectral index(BIS)was maintained at 40-45 for patients in BIS40 group,and the BIS was maintained at 55-60 for patients in BIS55 group.The hemodynamic indices of the patients were recorded at the immediate time point of pre-induction(T0),completion of induction(T1),immediately after establishment of pneumoperitoneum(T2),specimen collection(T3),irrigation(T4),completion of surgery(T5),extubation(T6)and return to the ward(T7).Venous blood was collected preoperatively,2 h,6 h and 24 h postoperatively for the determination of serum hemoglobin(NGB),hypoxia-inducible factor(HIF-α),neuron-specific enolase(NSE),S100-β,IL-6 and TNF-α,respectively.Results:Compared with BIS55 group,patients in BIS40 group had greater dosage of sevoflurane,lower BIS value,and prolonged time of extubation(P<0.05).The serum TNF-αand IL-6 levels of patients in BIS40 group were lower than those in BIS55 group at 2 h after surgery(P<0.05),and the differences in serum NGB,NSE,S100-β,and HIF-αlevels at the remaining time points were not statistically significant(P>0.05).Conclusion:Different depths of anesthesia within the recommended range of bispectral indices do not affect the index of postoperative brain injury after general anesthesia in elderly patients,but the level of inflammatory factors is lower in the e

关 键 词：脑损伤 脑电双频谱指数 麻醉深度 炎症因子 

分 类 号：R614[医药卫生—麻醉学]