本文選題：老年 + 術(shù)后認(rèn)知功能障礙　； 參考：《臨床麻醉學(xué)雜志》2016年02期

【摘要】：目的研究不同BIS值對(duì)全麻下老年患者腹部手術(shù)術(shù)后早期認(rèn)知功能及S100β蛋白的影響。方法選擇全麻下?lián)衿谛懈共渴中g(shù)的患者50例,男34例,女16例,年齡65~75歲,ASAⅠ或Ⅱ級(jí),按照隨機(jī)數(shù)字表法分為淺麻醉組(L組)和深麻醉組(D組),每組25例。L組BIS值維持在50~59,D組BIS值維持在30~39。記錄入室后靜臥5min(T0)、插管前即刻(T1)、手術(shù)切皮即刻(T2)、手術(shù)進(jìn)行2h時(shí)(T3)、手術(shù)進(jìn)行3h時(shí)(T4)、術(shù)畢(T5)時(shí)的BP、HR、SpO2、ECG、PETCO2、吸入麻醉藥濃度、BIS值;記錄兩組的麻醉時(shí)間、手術(shù)時(shí)間、術(shù)后1d的VAS評(píng)分、丙泊酚用量、芬太尼用量、咪達(dá)唑侖用量。于麻醉前10min、術(shù)畢及術(shù)后24、48h時(shí)采集血液標(biāo)本,測(cè)定S100β蛋白濃度;于術(shù)前1d及術(shù)后1、3、7d隨訪記錄患者M(jìn)MSE評(píng)分及TMT完成時(shí)間。結(jié)果 D組T2、T3、T4時(shí)BIS值明顯低于L組(P0.05);D組丙泊酚用量明顯多于L組(P0.05)。與麻醉前10min比較,術(shù)畢和術(shù)后48h兩組血清S100β蛋白含量明顯升高,術(shù)后24h兩組血清S100β蛋白含量有增高趨勢(shì),但差異無(wú)統(tǒng)計(jì)學(xué)意義;與術(shù)畢比較,術(shù)后24h兩組血清S100β蛋白含量明顯降低(P0.05),L組術(shù)畢、術(shù)后24h血清S100β蛋白含量明顯高于D組(P0.05)。與術(shù)前1d比較,術(shù)后1d兩組MMSE評(píng)分明顯降低,術(shù)后3dL組MMSE評(píng)分明顯降低(P0.01);與術(shù)后3d比較,術(shù)后7dL組MMSE評(píng)分明顯升高(P0.01);L組術(shù)后1、3d的MMSE評(píng)分明顯低于D組(P0.05)。與術(shù)前1d比較,術(shù)后1d兩組TMT完成時(shí)間明顯延長(zhǎng)(P0.01);與術(shù)后1d比較,術(shù)后3d兩組TMT完成時(shí)間明顯縮短(P0.01);與術(shù)后3d比較,術(shù)后7dL組的TMT完成時(shí)間明顯縮短(P0.01);術(shù)后1、3dL組TMT完成時(shí)間明顯長(zhǎng)于D組(P0.05)。術(shù)后1dL組POCD發(fā)生率明顯高于D組(P0.05)。結(jié)論不同麻醉深度均可保證老年患者術(shù)中和術(shù)后血流動(dòng)力學(xué)平衡,且術(shù)后均發(fā)生不同程度的認(rèn)知功能障礙,但術(shù)中將BIS值維持在30~39的深麻醉組血清S100β蛋白水平及早期POCD的發(fā)生率較低,術(shù)后認(rèn)知功能損傷程度較輕。
[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.
【作者單位】： 新疆石河子大學(xué)醫(yī)學(xué)院;石河子大學(xué)醫(yī)學(xué)院第一附屬醫(yī)院麻醉科;
【分類(lèi)號(hào)】：R614.2

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