[1]何花丽,鲁小红,赵晓娟.不同深度麻醉对老年腹部手术患者术后认知功能障碍及炎症反应的影响[J].新乡医学院学报,2018,35(3):207-211.[doi:10.7683/xxyxyxb.2018.03.012]
 HE Hua-li,LU Xiao-hong,ZHAO Xiao-juan.Effect of anesthesia at different depths on postoperative cognitive disfunction and inflammatory response in the elderly patients undergoing abdominal operation[J].Journal of Xinxiang Medical University,2018,35(3):207-211.[doi:10.7683/xxyxyxb.2018.03.012]
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不同深度麻醉对老年腹部手术患者术后认知功能障碍及炎症反应的影响
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
35
期数:
2018年3
页码:
207-211
栏目:
临床研究
出版日期:
2018-03-05

文章信息/Info

Title:
Effect of anesthesia at different depths on postoperative cognitive disfunction and inflammatory response in the elderly patients undergoing abdominal operation
作者:
何花丽1鲁小红2赵晓娟2
(1.陕西中医药大学第二临床医学院临床医学系,陕西 咸阳 712000;2.陕西中医药大学附属医院麻醉科,陕西 咸阳 712000)
Author(s):
HE Hua-li1LU Xiao-hong2ZHAO Xiao-juan2
(1.Department of Clinical Medicine,the Second Clinical Medical College,Shaanxi University of Chinese Medicine,Xianyang 712000,Shaanxi Province,China;2.Department of Anesthesiology,the Affiliated Hospital of Shaanxi University of Chinese Medicine,Xianyang 712000,Shaanxi Province,China)
关键词:
老年人腹部手术脑电双频指数麻醉深度术后认知功能障碍炎症反应
Keywords:
elderlyabdominal operationbispectral indexdepth of anesthesiapostoperative cognitive disfunctioninflammatory reaction
分类号:
R614.2
DOI:
10.7683/xxyxyxb.2018.03.012
文献标志码:
A
摘要:
目的 探讨不同深度麻醉对老年腹部手术患者术后认知功能障碍(POCD)及炎症反应的影响。方法 选择2014年6月至2016年6月于陕西中医药大学附属医院行腹部手术的老年患者90例,根据麻醉深度分为观察组和对照组,每组45例。2组患者均采取静脉-吸入复合麻醉,观察组患者术中脑电双频指数(BIS)维持在30~39,对照组患者术中BIS维持在50~59。记录2组患者入手术室时(T0)、气管插管后5 min(T1)、开腹时(T2)、关腹时(T3)、气管插管拔管时(T4)的平均动脉压(MAP)、心率(HR)变化;分别于术前及术后第1、3、7 天对2组患者进行简易智力状态检查(MMSE)评分,并统计POCD发生率;分别于术前、术毕及术后第1、3 天检测2组患者血清白细胞介素-6(IL-6)、S-100β蛋白水平。结果 对照组和观察组患者分别剔除5、6例,最终观察组39例、对照组40例患者获得评估。2组患者T1和T2 时MAP显著低于T0时(P<0.05),T3及T4时MAP与T0时比较差异无统计学意义(P>0.05);2组患者组内各时间点HR比较差异均无统计学意义(P>0.05),2组患者各时间点MAP、HR比较差异均无统计学意义(P>0.05)。2组患者术前MMSE评分比较差异无统计学意义(P>0.05);2组患者术后第1、3天MMSE评分显著低于术前及术后第7天(P<0.05),2组患者术后第7天MMSE评分与术前比较差异均无统计学意义(P>0.05);术后第1、3天,观察组患者MMSE评分显著高于对照组(P<0.05);术后第7天,2组患者MMSE评分比较差异无统计学意义(P>0.05)。术后第1、3、7天,观察组患者POCD发生率分别为28.21%(11/39)、15.38%(6/39)和7.69%(3/39),对照组患者POCD发生率分别为50.00%(20/40)、37.50%(15/40)和20.00%(8/40);术后第1、3天,观察组患者POCD发生率显著低于对照组(χ2=3.934、4.949,P<0.05);术后第7天2组患者POCD发生率比较差异无统计学意义(χ2=2.496,P>0.05)。2组患者术前血清IL-6及S-100β蛋白水平比较差异均无统计学意义(P>0.05);术毕及术后第1、3天时2组患者血清IL-6及S-100β蛋白水平均显著高于术前(P<0.05);术毕及术后第1、3天,观察组患者血清IL-6及S-100β蛋白水平均显著低于对照组(P<0.05)。结论 深度麻醉(BIS维持在30~39)可降低老年腹部手术患者术后炎性因子水平和POCD发生率,减轻脑损伤。
Abstract:
Objective To investigate the effect of anesthesia at different depths on postoperative cognitive disfunction(POCD) and inflammatory response in the elderly patients undergoing abdominal operation.Methods A total of 90 elderly patients who underwent abdominal operation in the Affiliated Hospital of Shaanxi University of Chinese Medicine from June 2014 to June 2016 were divided into observation group and control group according to the depth of anesthesia,45 cases in each group.The patients in the two groups were performed with combined intravenous and inhalation anesthesia,the bispectral index(BIS) value was maintained at 30-39 during the operation in the observation group,and the BIS value was maintained at 50-59 during the operation in the control group.The mean arterial pressure (MAP) and heart rate(HR) of patients in the two groups were recorded at the time points of entering the operation room(T0),5 minutes after tracheal cannula(T1),opening abdominal cavity(T2),closing abdominal cavity(T3) and tracheal cannula extubation(T4).The mini-mental state examination(MMSE) score of the patients in the two groups was performed before operation and the first,third,seventh day after operation;and the incidence of POCD was recorded.The levels of serum interleukin-6(IL-6) and S-100β protein were detected at the time points of before operation,the end of the operation and the first,third day after operation in the two groups.Results Five cases in the control group and six cases in the observation group were eliminated,39 cases in the observation group and 40 cases in the control group were evaluated finally.The MAP at T1 and T2 was significantly lower than that at T0 in the two groups(P<0.05).There was no significant difference in the MAP between T3,T4 and T0 in the two groups(P>0.05).There was no significant difference in the HR each time point in each group(P>0.05).There was no significant difference in the MAP and HR between the two groups at each time point(P>0.05).There was no significant difference in the MMSE score between the two groups before operation(P>0.05).The MMSE score of patients at the first and third day after operation was significantly lower than that before operation and the seventh day after operation in the two groups(P<0.05).There was no significant difference in the MMSE score between before operation and the seventh day after operation in the two groups(P>0.05).The MMSE score in the observation group was significantly higher than that in the control group at the first and third day after operation(P<0.05).There was no significant difference in the MMSE score between the two groups at the seventh day after operation(P>0.05).The incidences of POCD at the first,third and seventh day after operation in the observation group were 28.21%(11/39),15.38%(6/39) and 7.69%(3/39) respectively;and they were 50.00%(20/40),37.50%(15/40) and 20.00%(8/40) respectively in the control group.The incidence of POCD in the observation group was significantly lower than that in the control group at the first and third day after operation(χ2=3.934,4.949;P<0.05).There was no significant difference in the incidence of POCD between the two groups at the seventh day after operation(χ2=2.496,P>0.05).There was no significant difference in the levels of serum IL-6 and S-100β protein between the two groups before operation(P>0.05).The levels of serum IL-6 and S-100β protein at the end of operation and the first,third day after operation were significantly higher than those before operation in the two groups(P<0.05).The levels of serum IL-6 and S-100β protein in the observation group were significantly lower than those in the control group at the end of operation and the first,third day after operation(P<0.05).Conclusion Deep anesthesia(BIS value is maintained at 30-39) can reduce the levels of inflammatory factors,the incidence of POCD after operation and the brain damage in the elderly patients with abdominal operation.

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更新日期/Last Update: 2018-03-05