不同BIS值对全麻下老年患者腹部手术术后早期认知功能及S100β蛋白的影响

发布时间：2018-06-21 08:54

  本文选题：老年 + 术后认知功能障碍　； 参考：《临床麻醉学杂志》2016年02期

【摘要】：目的研究不同BIS值对全麻下老年患者腹部手术术后早期认知功能及S100β蛋白的影响。方法选择全麻下择期行腹部手术的患者50例,男34例,女16例,年龄65~75岁,ASAⅠ或Ⅱ级,按照随机数字表法分为浅麻醉组(L组)和深麻醉组(D组),每组25例。L组BIS值维持在50~59,D组BIS值维持在30~39。记录入室后静卧5min(T0)、插管前即刻(T1)、手术切皮即刻(T2)、手术进行2h时(T3)、手术进行3h时(T4)、术毕(T5)时的BP、HR、SpO2、ECG、PETCO2、吸入麻醉药浓度、BIS值;记录两组的麻醉时间、手术时间、术后1d的VAS评分、丙泊酚用量、芬太尼用量、咪达唑仑用量。于麻醉前10min、术毕及术后24、48h时采集血液标本,测定S100β蛋白浓度;于术前1d及术后1、3、7d随访记录患者MMSE评分及TMT完成时间。结果 D组T2、T3、T4时BIS值明显低于L组(P0.05);D组丙泊酚用量明显多于L组(P0.05)。与麻醉前10min比较,术毕和术后48h两组血清S100β蛋白含量明显升高,术后24h两组血清S100β蛋白含量有增高趋势,但差异无统计学意义;与术毕比较,术后24h两组血清S100β蛋白含量明显降低(P0.05),L组术毕、术后24h血清S100β蛋白含量明显高于D组(P0.05)。与术前1d比较,术后1d两组MMSE评分明显降低,术后3dL组MMSE评分明显降低(P0.01);与术后3d比较,术后7dL组MMSE评分明显升高(P0.01);L组术后1、3d的MMSE评分明显低于D组(P0.05)。与术前1d比较,术后1d两组TMT完成时间明显延长(P0.01);与术后1d比较,术后3d两组TMT完成时间明显缩短(P0.01);与术后3d比较,术后7dL组的TMT完成时间明显缩短(P0.01);术后1、3dL组TMT完成时间明显长于D组(P0.05)。术后1dL组POCD发生率明显高于D组(P0.05)。结论不同麻醉深度均可保证老年患者术中和术后血流动力学平衡,且术后均发生不同程度的认知功能障碍,但术中将BIS值维持在30~39的深麻醉组血清S100β蛋白水平及早期POCD的发生率较低,术后认知功能损伤程度较轻。
[Abstract]:Objective to study the effect of different BIS values on the early cognitive function and S100 beta protein in the elderly patients undergoing abdominal surgery under general anesthesia. Methods 50 patients with abdominal surgery under general anesthesia, 34 men, 16 women, age 65~75, ASA I or II were divided into shallow anesthesia group (group L) and deep anesthesia group (group D), 25 cases of.L in each group. The BIS value of the group was maintained at 50~59, and the BIS value of the group D was maintained at 5min (T0) after the 30~39. record, and the operation was immediately T1, the operation was performed immediately (T2), the operation carried out 2H (T3). The dosage of phenolol, the dosage of fentanyl, and midazolam dosage. The blood samples were collected at 10min before anesthesia, after the operation and 24,48h after the operation, and the concentration of S100 beta protein was measured. The MMSE score and the completion time of TMT were recorded at 1D and 1,3,7d follow up before operation. Results the BIS values of T2, T3 and T4 in D group were significantly lower than those in group D. 5. Compared with 10min before anesthesia, the serum levels of S100 beta protein in the 48h two groups were significantly higher after the operation and after the operation. The serum S100 beta protein content in the 24h two groups was higher, but the difference was not statistically significant; the serum S100 beta protein content in the 24h two groups after the operation was significantly lower (P0.05), and the S100 beta protein content in the 24h serum of the 24h serum was significantly higher after the operation. In group D (P0.05). Compared with preoperative 1D, MMSE scores in group 1D two were significantly reduced and MMSE scores in group 3dL decreased significantly after operation (P0.01). Compared with postoperative 3D, MMSE score in group 7dL group was significantly higher (P0.01). Compared with 1D, the completion time of TMT in group 3D two was significantly shortened (P0.01). Compared with 3D after operation, the completion time of TMT in group 7dL was significantly shorter (P0.01), and TMT completion time of group 1,3dL was significantly longer than D group (P0.05) after operation. Dynamic balance, and postoperative cognitive dysfunction in different degree, but in operation, BIS value was maintained at 30~39 deep anesthesia group serum S100 beta protein level and early POCD, lower incidence of postoperative cognitive function damage degree is lighter.
【作者单位】： 新疆石河子大学医学院;石河子大学医学院第一附属医院麻醉科;
【分类号】：R614.2

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