[1]尹士林.不同镇静深度对老年患者术后认知功能的影响[J].新乡医学院学报,2020,37(10):972-975.[doi:10.7683/xxyxyxb.2020.10.016]
　YIN Shilin.Effects of different sedation depth on postoperative cognitive function in elderly patients[J].Journal of Xinxiang Medical University,2020,37(10):972-975.[doi:10.7683/xxyxyxb.2020.10.016]
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不同镇静深度对老年患者术后认知功能的影响
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
37
期数:
2020年10
页码:
972-975
栏目:
临床研究
出版日期:
2020-10-05

文章信息/Info

Title:
Effects of different sedation depth on postoperative cognitive function in elderly patients
作者:
尹士林
（信阳市中心医院麻醉科，河南　信阳　464000）
Author(s):
YIN Shilin
(Department of Anesthesia，the Central Hospital of Xinyang City，Xinyang 464000，Henan Province，China)
关键词:
老年人; 认知障碍; 脑电双频谱指数; 炎症反应
Keywords:
the elderly; cognitive impairment; bispectral index; inflammatory response
分类号:
R614
DOI:
10.7683/xxyxyxb.2020.10.016
文献标志码:
A
摘要:
目的　探讨不同镇静深度对术前合并轻度认知功能障碍老年患者术后认知功能的影响。方法　选择2018年1月至2019年12月信阳市中心医院收治的全身麻醉下行普外科胃肠道手术的老年患者152例为研究对象。根据术中不同镇静深度将患者分为脑电双频谱指数（BIS）40～50组（n=75）和BIS 50～60组（n=77）。麻醉诱导后，采用闭环靶控输注系统靶控输注丙泊酚，自动调节其血浆浓度，靶控输注瑞芬太尼，维持血浆质量浓度2～6 μg·L-1，BIS 40～50组患者术中维持BIS为40～50，BIS 50～60组患者术中维持BIS为50～60。分别于术前1 d（T0）和术后7 d（T1）检测2组患者血清白细胞介素（IL）-6、IL-10、肿瘤坏死因子-α（TNF-α）水平，采用蒙特利尔认知量表（MoCA）和简易精神状态检查量表（MMSE）评估患者的认知功能，并观察术后不良反应发生情况。结果　2组患者麻醉时间、手术时间、术中出血量、术中心动过缓、术中低血压等比较差异无统计学意义（P>0.05）。2组患者T0时MoCA和MMSE评分比较差异无统计学意义（P>0.05）；2组患者T1时MoCA和MMSE评分低于T0时（P<0.05）。与BIS 40～50组比较，BIS 50～60组患者T1时MoCA和MMSE评分降低（P<0.05）。BIS 40～50组和BIS 50～60组患者术后认知功能障碍（POCD）发生率分别为 9.33%（7/75）和20.78%（16/77）；BIS 50～60组患者POCD发生率高于BIS 40～50组（χ2=3.880，P<0.05）。2组患者T0时血清IL-6、IL-10和TNF-α水平比较差异无统计学意义（P>0.05）；2组患者T1时血清IL-6、IL-10和TNF-α水平高于T0时（P<0.05）。与BIS 40～50组比较，BIS 50～60组患者T1时血清IL-6和TNF-α水平升高，IL-10水平降低（P<0.05）。BIS 40～50组和BIS 50～60组患者术后不良反应发生率分别为26.67%（20/75）和24.68%（19/77）；2组患者术后不良反应发生率比较差异无统计学意义（χ2=0.080，P>0.05）。结论　术中维持BIS为40～50可有效降低轻度认知功能障碍老年患者POCD的发生。
Abstract:
Objective　To explore the effect of different sedation depth on postoperative cognitive function in the elderly patients with mild cognitive impairment before surgery.Methods　A total of 152 elderly patients undergoing gastrointestinal surgery under general anesthesia in the Central Hospital of Xinyang City from January 2018 to December 2019 were selected as the study subjects.According to the bispectral index（BIS） value,the patients were randomly divided into BIS 40-50 group(n=75) and BIS 50-60 group (n=77).After induction of anesthesia,propofol was administered by closed-loop target-controlled infusion to automatically regulate the plasma target concentration.The target concentration of plasma remifentanil was controlled to be 2-6 μg·L-1.The BIS of the patients in the BIS 40-50 group was maintained at 40-50,while it was maintained at 50-60 in the BIS 50-60 group.Serum levels of interleukin(IL)-6,IL-10 and tumor necrosis factor-α（TNF-α） were measured and the cognitive function was evaluated by montreal cognitive assessment (MoCA) and mini-mental state examination (MMSE) at one day before surgery (T0) and seven days after surgery (T1),respectively.The occurrence of postoperative adverse reactions was observed.Results　There was no significant difference in the anesthesia time,operation time,intraoperative blood loss,intraoperotive bradycardia and intraoperative hypotension between the two groups (P>0.05).There was no significant difference in the MoCA and MMSE scores between the two groups at T0 (P>0.05).The MoCA and MMSE scores at T1 were lower than those at T0 in the two groups(P<0.05).The MoCA and MMSE scores at T1 in the BIS 50-60 group were lower than those in the BIS 40-50 group (P<0.05).The incidence of postoperative cognitive dysfunction （POCD） was 9.33% (7/75) and 20.78% (16/77) in the BIS 40-50 group and BIS 50-60 group,respectively.The incidence of POCD in the BIS 50-60 group was higher than that in the BIS 40-50 group (χ2=3.880,P<0.05).There was no significant difference in the serum levels of IL-6,IL-10 and TNF-α between the two groups at T0 (P>0.05).The serum levels of IL-6,IL-10 and TNF-α at T1 were higher than those at T0 in the two groups(P<0.05).Compared with the BIS 40-50 group,the serum IL-6 and TNF-α levels were higher and the IL-10 level was lower in the BIS 50-60 group at T1 (P<0.05).The incidence of adverse reaction in the BIS 40-50 group and the BIS 50-60 group was 26.67% (20/75) and 24.68% (19/77),respectively.There was no significant difference in the incidence of adverse reaction between the two groups (χ2=0.080,P>0.05).Conclusion　Maintaining BIS value at 40-50 during operation can decrease the development of POCD in the elderly patients with mild cognitive impairment.

参考文献/References:

［1］　EVERED L A,SILBERT B S.Postoperative cognitive dysfunction and noncardiac surgery［J］.Anesth Analg,2018,127(2):496-505.
［2］　KOYAMA T,KAWANO T,IWATA H,et al.Acute postoperative pain exacerbates neuroinflammation and related delirium-like cognitive dysfunction in rats［J］.J Anesth,2019,33(3):482-486.
［3］　KRISTEK G,RADOS I,KRISTEK D,et al.Influence of postoperative analgesia on systemic inflammatory response and postoperative cognitive dysfunction after femoral fractures surgery:a randomized controlled trial［J］.Reg Anesth Pain Med,2019,44(1):59-68.
［4］　刘智,滕永杰,何慧鑫.针刺麻醉与气体麻醉对老年患者术后认知功能障碍及NSE、S-100β蛋白水平变化的影响［J］.世界中医药,2018,13(11):2858-2861.
［5］　WU Z，ZHANG M，ZHANG Z,et al.Ratio of β-amyloid protein (Aβ) and tau predicts the postoperative cognitive dysfunction on patients undergoing total hip/knee replacement surgery［J］.Exp Ther Med,2018,15(1):878-884.
［6］　JOSHI G P,CUSHNER F D,BARRINGTON J W,et al.Techniques for periarticular infiltration with liposomal bupivacaine for the management of pain after hip and knee arthroplasty:a consensus recommendation［J］.J Surg Orthop Adv,2015,24(1):27-35.
［7］　SILBERT B,EVERED L,SCOTT D,et al.Preexisting cognitive impairment is associated with postoperative cognitive dysfunction after hip joint replacement surgery［J］.Anesthesiology,2015,122(6):1224-1234.
［8］　ZHANG D,NIE A.Assessment of different anesthesia depth under total intravenous anesthesia on postoperative cognitive function in laparoscopic patients［J］.J Res Med Sci,2016,21(5):73-77.
［9］　陈一萌,王海云,王红柏,等.丙泊酚/七氟醚不同配伍麻醉对轻度认知功能障碍老年患者术后认知功能的影响［J］.中华麻醉学杂志,2017,37(9):1087-1090.
［10］　李红,刘叶,吴军娜,等.不同镇静深度对轻度认知功能障碍老年患者术后认知功能的影响［J］.中华麻醉学杂志,2018,38(12):1437-1440.
［11］　李晶晶,马卫兰,邓立琴,等.全膝关节置换术老年患者术后认知功能障碍的危险因［J］.中华麻醉学杂志,2019,39(2):158-161.
［12］　TALEB-BELKADI O,CHAIB H,ZEMOUR L,et al.Lipid profile,inflammation,and oxidative status in peri- and postmenopausal women［J］.Gynecol Endocrinol,2016,32(12):982-985.
［13］　张桂欣.布地奈德混悬液和复方异丙托溴铵溶液雾化吸入对肺炎支原体肺炎患儿肺功能及炎性因子和预后的影响［J］.新乡医学院学报,2019,36(12):1171-1174.
［14］　BAGHEL K,SRIVASTAVA R N,CHANDRA A,et al.TNF-α,IL-6,and IL-8 cytokines and their association with TNF-α-308 G/A polymorphism and postoperative sepsis［J］.J Gastrointest Surg,2014,18(8):1486-1494.
［15］　JIANG J,LV X,LIANG B,et al.Circulating TNF-α levels increased and correlated negatively with IGF-I in postoperative cognitive dysfunction［J］.Neurol Sci,2017,38(8):1391-1392.
［16］　张一,姚秋近,陈超,等.蒙特利尔认知评估量表在筛查老年颅脑创伤患者认知障碍中的应用研究［J］.中华老年医学杂志,2014,33(7):729-732.
［17］　王昆,李成文,史继红,等.右美托咪定复合舒芬太尼自控静脉镇痛对老年脊柱手术患者术后认知功能的影响［J］.中华医学杂志,2015,95(30):2437-2441.

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更新日期/Last Update: 2020-10-05