局部脑氧饱和度监测目标导向管理对行腹腔镜肝切除术老年肝癌患者术后认知功能的影响  

Effect of goal-directed management based on regional cerebral oxygen saturation monitoring on postoperative cognitive function in elderly patients with hepatocellular carcinoma undergoing laparoscopic hepatectomy

作　　者：周兴 杨吉安 彭凡凡 何丽丽 刘媛媛 何军民 马晓兰 任志艳 杨培豪 ZHOU Xing;YANG Ji´an;PENG Fanfan;HE Lili;LIU Yuanyuan;HE Junmin;MA Xiaolan;REN Zhiyan;YANG Peihao(Department of Anesthesiology,Jingmen People's Hospital(Jingmen People's Hospital Affiliated to Jingchu University of Technology),Jingmen 448000,China)

机构地区：[1]荆门市人民医院(荆楚理工学院附属荆门市人民医院)麻醉科,湖北荆门448000

出　　处：《山东医药》2025年第4期78-82,共5页Shandong Medical Journal

基　　金：湖北省荆门市科学技术研究与开发计划项目(2021YFYB021)。

摘　　要：目的观察局部脑氧饱和度(rSO_(2))监测目标导向管理对行腹腔镜肝切除术老年肝癌患者术后认知功能的影响。方法选取择期行腹腔镜肝切除术老年肝癌患者60例,用随机数字表法将其分为观察组和对照组,每组30例,观察组术中根据rSO_(2)值调整麻醉,对照组术中根据麻醉医生经验进行麻醉处理。记录围手术期神经认知障碍(PND)发生率及手术前后(术前1 d和术后1、3 d)简易精神状态检查量表(MMSE)评分,采用酶联免疫吸附试验检测手术前后(术前1 d和术后1、3 d)血清神经元特异性烯醇化酶(NSE)、S100钙结合蛋白β亚型(S100β),记录不同时点[麻醉诱导前(T_(0))、麻醉诱导后5 min(T_(1))、手术开始后1 h(T_(2))、术毕(T_(3))、拔管时(T_(4))]平均动脉压(MAP)、心率(HR)、rSO_(2)、麻醉深度指数(CSI),另记录rSO_(2)基线值(rSO_(2)baseline)、术中rSO_(2)最小值(rSO_(2min))、rSO_(2)平均值(rSO_(2mean))、rSO_(2)较基线值下降的最大百分数(rSO_(2%max)),采用酶联免疫吸附试验检测血清C反应蛋白(CRP)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)。结果与对照组比较,观察组术后1、3 d的PND发生率降低(P均<0.05)。与对照组比较,观察组术后1 d的MMSE评分升高和血清NSE、S100β水平降低,术后3 d血清NSE、S100β水平降低(P均<0.05);与同组术前1 d比较,两组术后1 d和3 d的MMSE评分降低和血清NSE、S100β水平升高(P均<0.05)。与对照组比较,观察组T_(2)、T_(3)时点MAP和rSO_(2)升高(P均<0.05);与同组T_(0)时点比较,两组T_(1)、T_(2)、T_(3)时点MAP和rSO_(2)降低,T_(1)、T_(2)、T_(3)、T_(4)时点HR、CSI降低(P均<0.05)。与对照组比较,观察组rSO_(2min)、rSO_(2mean)升高,rSO_(2mean)、rSO_(2%max)降低(P均<0.05)。与对照组比较,观察组术后1 d和3 d血清CRP、IL-6、TNF-α水平降低(P均<0.05);与同组术前1 d比较,两组术后1 d和3 d血清CRP、IL-6、TNF-α水平升高(P均<0.05)。结论rSO_(2)监测目标导向管�Objective To observe the effect of goal-directed management based on regional cerebral oxygen satura-tion(rSO_(2))monitoring on postoperative cognitive function in elderly patients with hepatocellular carcinoma undergoing lap-aroscopic hepatectomy.Methods Sixty elderly patients with hepatocellular carcinoma undergoing laparoscopic hepatec-tomy were selected and randomly divided into the observation group and control group with 30 cases in each group.Anes-thesia in the observation group was adjusted according to rSO_(2) value during operation,while anesthesia in the control group was performed according to anesthesiologist experience.The incidence of perioperative neurocognitive disorders(PND)and the score of the Mini-Mental State Examination Scale(MMSE)before and after surgery(1 d before and 1 and 3 d after surgery)were recorded.Serum neuron-specific enolase(NSE)and S100 calc-binding proteinβsubtype(S100β)were de-tected by enzymed-linked immunosorbent assay(ELISA)before and after surgery(1 d before and 1 and 3 d after surgery).Mean arterial pressure(MAP),heart rate(HR),rSO_(2) and cerebral state index(CSI)were recorded at different time points[before anesthesia induction(T_(0)),5 min after anesthesia induction(T_(1)),1 h after surgery(T_(2)),after surgery(T_(3)),and at extubation(T_(4))].The baseline rSO_(2)(rSO_(2)baseline),the minimum rSO_(2)(rSO_(2min))during operation,the mean rSO_(2)(rSO_(2mean)),and the maximum percentage of rSO_(2) decrease from baseline(rSO_(2%max))were also recorded.Serum C-reac-tive protein(CRP),interleukin-6(IL-6)and tumor necrosis factorα(TNF-α)were detected by enzyme-linked immuno-sorbent assay.Results Compared with the control group,the incidence of PND in the observation group decreased at 1 and 3 d after operation(P<0.05).Compared with the control group,the MMSE score and serum NSE and S100βlevels in the observation group increased at 1 d after surgery,and serum NSE and S100βlevels decreased at 3 d after surgery(all P<0.05).Compared with the same group at 1 d before surgery,

关 键 词：局部脑氧饱和度 腹腔镜肝切除术 肝癌 认知功能 围手术期神经认知障碍 

分 类 号：R614.2[医药卫生—麻醉学]